Single-center outcomes of combined heart and liver transplantation in the failing Fontan

Benjamin A. D'Souza, Stephanie Fuller, Lacey P. Gleason, Nicole Hornsby, Joyce Wald, Karen Krok, Abraham Shaked, Lee R. Goldberg, Alberto Pochettino, Kim M. Olthoff, Yuli Y. Kim

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21 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article numbere12892
JournalClinical Transplantation
Volume31
Issue number3
DOIs
StatePublished - Mar 1 2017

All Science Journal Classification (ASJC) codes

  • Transplantation

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    D'Souza, B. A., Fuller, S., Gleason, L. P., Hornsby, N., Wald, J., Krok, K., Shaked, A., Goldberg, L. R., Pochettino, A., Olthoff, K. M., & Kim, Y. Y. (2017). Single-center outcomes of combined heart and liver transplantation in the failing Fontan. Clinical Transplantation, 31(3), [e12892]. https://doi.org/10.1111/ctr.12892