CONTEMPORARY OUTCOMES OF COMBINED HEART-LIVER TRANSPLANT IN PATIENTS WITH CONGENITAL HEART DISEASE

ABSTRACT Background As more patients survive into adulthood with repaired congenital heart disease (CHD), transplant centers now have patients presenting with both end stage cardiac and hepatic failure. An understanding of the contemporary outcomes with combined heart liver transplantation (CHLT) in patients with CHD is needed. Methods A retrospective review of the outcomes of CHLT in CHD was conducted from 10/1/87 to 6/30/15 from United Network of Organ Sharing (UNOS) database. Propensity score matched cohorts were formed for the assessment of posttransplant outcome: CHLT with CHD, CHLT without CHD, and isolated heart transplant for congenital heart disease (HT-CHD). Cohorts were matched based on age, body-mass index, inotrope use, and ventilator support at the time of transplant. We assessed 30-day, 1-, 5-, and 10-year posttransplant survival. Results There were 61,437 heart transplants during the study period, out of which 190 (0.3%) were CHLT. Among CHLT, 41(22%) patients had CHD. In 26 (63%) of these, the indication for CHLT was hepatic congestion/cirrhosis of cardiac origin. In the matched cohorts, the overall survival for CHLT with CHD at 30-days, 1, 5, and 10-years was 95%, 86%, 83%, and 83% respectively; for CHLT without CHD, it was 100%, 92%, 92% and 63% respectively (versus CHLT with CHD: p=0.49); and for HT-CHD, it was 90%, 84%, 63%, and 39% (versus CHLT with CHD: p=0.03) respectively. Conclusions The posttransplant outcome of CHLT, with and without CHD, is comparable. But there is a trend towards better survival for CHLT for CHD compared to isolated heart transplant for CHD. Corresponding author before publication: Raheel Rizwan, MD, Research Fellow, Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Location S4.200AI, Cincinnati, Ohio 45229, Phone: 513-636-0902. Raheel.Rizwan@cchmc.org; Corresponding author after publication: Roosevelt Bryant III, MD, Associate Professor of Surgery, Surgical Director, Pediatric Heart Transplant Program, Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, 3333 Burnet Avenue – MLC 2004, Cincinnati, Ohio 45229, Phone: 513-636-4770, Fax: 513-636-3847. Roosevelt.BryantIII@cchmc.org AUTHORSHIP: Roosevelt Bryant 3rd Participated in idea, design and writing the manuscript Raheel Rizwan, MD: Participated in design, statistical analysis and writing the manuscript Farhan Zafar, MD: Participated in design, statistical analysis, review of the manuscript and suggestions to make the manuscript more yielding Shimul A. Shah: Participated in review of the manuscript and suggestions to make the manuscript more yielding Clifford Chin, MD: Participated in review of the manuscript and suggestions to make the manuscript more yielding James Tweddell, MD: Participated in review of the manuscript and suggestions to make the manuscript more yielding David L.S. Morales, MD: Participated in idea, design, review of the manuscript and suggestions to make the manuscript more yielding Disclosure(s): None of the authors have any disclosures related to the manuscript Funding Source(s): None Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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