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Single‐center outcomes of combined heart and liver transplantation in the failing Fontan
Author(s) -
D'Souza Benjamin A.,
Fuller Stephanie,
Gleason Lacey P.,
Hornsby Nicole,
Wald Joyce,
Krok Karen,
Shaked Abraham,
Goldberg Lee R.,
Pochettino Alberto,
Olthoff Kim M.,
Kim Yuli Y.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12892
Subject(s) - medicine , perioperative , liver transplantation , fontan procedure , cirrhosis , surgery , transplantation , single center , concomitant , retrospective cohort study , heart transplantation , heart failure , cardiology , heart disease
Long‐term outcomes of the Fontan operation include Fontan failure and liver disease. Combined heart‐liver transplantation ( CHLT ) is an option for select patients although limited data exist on this strategy. A retrospective review of Fontan patients 18 years or older referred for cardiac transplant evaluation between 2000 and 2013 at the Hospital of the University of Pennsylvania was performed. All patients were considered for potential CHLT . Clinical variables such as demographics, perioperative factors, and short‐term outcomes were reviewed. Of 17 referrals for cardiac transplantation, seven Fontan patients underwent CHLT . All patients who underwent CHLT had either advanced fibrosis or cirrhosis on liver biopsy. There were no perioperative deaths. The most common postoperative morbidity was acute kidney injury. Short‐term complications include one episode of acute liver rejection but no cardiac rejection greater than 1R. CHLT is an acceptable therapeutic option for patients with failing Fontan physiology who exhibit concomitant advanced liver fibrosis. However, optimal patient selection is currently undefined, and long‐term outcomes are not known.