1. Single-center outcomes of combined heart and liver transplantation in the failing Fontan
- Author
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Benjamin D’Souza, Abraham Shaked, Lacey P. Gleason, Nicole Hornsby, Kim M. Olthoff, Yuli Y. Kim, Stephanie Fuller, Karen L. Krok, Lee R. Goldberg, Alberto Pochettino, and Joyce Wald
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Cirrhosis ,Heart Diseases ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,030230 surgery ,Liver transplantation ,Fontan Procedure ,Single Center ,Young Adult ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Transplantation ,medicine.diagnostic_test ,business.industry ,Liver Diseases ,Graft Survival ,Acute kidney injury ,Perioperative ,Prognosis ,medicine.disease ,Liver Transplantation ,Surgery ,surgical procedures, operative ,Liver biopsy ,cardiovascular system ,Cardiology ,Heart Transplantation ,Female ,business ,Follow-Up Studies - 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.
- Published
- 2017
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