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Combined Heart Transplantation with Other Organ Transplantation

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Contemporary Heart Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Patients with end-stage heart failure often have comorbid failure of another organ as a sequelae of advanced heart disease or an underlying systemic disease affecting multiple organs. In select patients, combined heart-lung, heart-liver, or heart-kidney transplantation is the only definitive therapy to extend survival and improve quality of life. One challenge in combined transplant is the absence of standardized guidelines to identify appropriate candidates, with variable practices among transplant centers. Once listed for transplant, combined transplant patients have universally higher wait list mortality than isolated heart transplant patients. Combined transplantation remains relatively rare, comprising only a small amount of the total organ transplantation performed annually. These patients typically have good outcomes, with survival after heart-lung transplant on par with isolated lung transplant and survival after heart-liver and heart-kidney transplant similar to isolated heart transplant. Patients who undergo dual solid organ transplantation enjoy lower rates of rejection than isolated heart transplantation with similar rates of other posttransplant complications including infection and malignancy.

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References

  • Atluri P, Gaffey A, Howard J et al (2014) Combined heart and liver transplantation can be safely performed with excellent short- and long-term results. Ann Thorac Surg 98:858–862

    Article  PubMed  Google Scholar 

  • Awad M, Czer LSC, Esmailan F et al (2016) Combined heart and kidney transplantation: a 23 year experience. Transplant Proc 49:348–353

    Article  Google Scholar 

  • Barbara DW, Rehfeldt KH, Heimbach JK et al (2015) The perioperative management of patients undergoing combined heart-liver transplantation. Transplantation 99(1):139–144

    Article  PubMed  Google Scholar 

  • Beal EW, Mumtaz K, Haynes D et al (2016) Combined heart-liver transplantation: indications, outcomes, and current experience. Transplant Rev 30:261–268

    Article  Google Scholar 

  • Bradley EA, Pinyoluksana K, Moore-Clingenpeel M et al (2017) Isolated heart transplant and combined heart-liver transplant in adult congenital heart disease patients: insights from the united network of organ sharing. Int J Card 228:790–795

    Article  Google Scholar 

  • Bruschi G, Busnach G, Colombo T et al (2007) Long-term follow-up of simultaneous heart and kidney transplantation with single donor allografts: report of nine cases. Ann Thorac Surg 84:522–527

    Article  PubMed  Google Scholar 

  • Cannon RM, Hughes MG, Jones CM et al (2012) A review of the United States experience with combined heart-liver transplantation. Transplant Int 25:1223–1228

    Article  Google Scholar 

  • Ceulemans LJ, Strypstein S, Neyrinck A et al (2016) Combined liver-thoracic transplantation: single-center experience with introduction of the ‘liver-first’ principle. Transplant Int 29:715–726

    Article  Google Scholar 

  • Chaperlier A, Vouche P, Maccinari P et al (1993) Comparative outcome of heart-lung and lung transplant for pulmonary hypertension. J Thorac Cardiovasc Surg 106(2):299–307

    Google Scholar 

  • D’Souza BA, Fuller S, Gleason L et al (2016) Single-center outcomes of combined heart and liver transplantation in the failing Fontan. Clin Transpl 31:e12892. https://doi.org/10.1111/ctr.12892

    Article  Google Scholar 

  • Davies HF, Pollard SG, Calane RY (1989) Soluble HLA antigens in the circulation of liver graft recipients. Transplantation 47(3):524–527

    Article  CAS  PubMed  Google Scholar 

  • Dell’Amore A, Botta L, Gallieri S et al (2006) Extracorporeal membrane oxygenator assistance as “bridge” to combined heart and liver transplantation. Transplant Proc 38:3004–3005

    Article  PubMed  Google Scholar 

  • Ferdinande P, Bruynincks F, Van Raemdonck D et al (2004) Phrenic nerve dysfunction after heart-lung and lung transplantation. J Heart Lung Transplant 23(1):105–109

    Article  CAS  PubMed  Google Scholar 

  • Goldberg DJ, French B, McBride MG et al (2011) Impact of oral sildenafil on exercise performance in children and young adults after the Fontan operation: a randomized, double-blind, placebo-controlled, cross-over trial. Circulation 123:1185–1198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hayes D, McConnell PI, Yates AR (2016) Induction immunosuppression for combined heart-lung transplantation. Clin Transpl 30:1332–1339

    Article  CAS  Google Scholar 

  • Hill C, Maxwell B, Boulate D et al (2015) Heart-lung vs. double-lung transplantation for idiopathic pulmonary arterial hypertension. Clin Transpl 29:1067–1075

    Article  Google Scholar 

  • Idrees JJ, Pettersson GB (2016) State of the art of combined heart-lung transplantation for advanced cardiac and pulmonary dysfunction. Cur Cardiol Rep 18:36

    Article  Google Scholar 

  • Jamieson SW, Baldwin J, Stinson EB et al (1984) Clinical heart-lung transplantation. Transplantation 37(1):81–84

    Article  CAS  PubMed  Google Scholar 

  • Jayarajan SN, Taghavi S, Komaroff E et al (2014) Impact of extracorporeal membrane oxygenation or mechanical ventilation as a bridge to combined heart-lung transplantation on short-term and long-term survival. Transplantation 97(1):111–115

    Article  CAS  PubMed  Google Scholar 

  • Karamlou T, Welke KF, McMullan M et al (2014) Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database. J Thorac Cardiovasc Surg 147:456–461

    Article  PubMed  Google Scholar 

  • Kramer MR, Marshall SE, Starnes VA (1993) Infectious complications in heart-lung transplantation. Arch Intern Med 153:2010–2016

    Article  CAS  PubMed  Google Scholar 

  • Kumarasinghe G, Lavee O, Parker A et al (2015) Post-transplant lymphoproliferative disease in heart and lung transplantation: defining risk and prognostic factors. J Heart Lung Transplant 34(11):1406–1414

    Article  PubMed  Google Scholar 

  • Labban B, Crew RJ, Cohen DJ (2009) Combined heart-kidney transplantation: a review of recipient selection and patient outcomes. Adv Chronic Kidney Dis 16(4):288–296

    Article  PubMed  Google Scholar 

  • Lopez-Sainz A, Barge-Caballero E, Paniagua-Martin MJ et al (2015) Clinical characteristics and long-term outcomes of patients undergoing combined heart-kidney transplantation: a single-center experience. Transplant Proc 47:123–126

    Article  CAS  PubMed  Google Scholar 

  • Menachem JN, Globus JR, Molina M et al (2017) Successful cardiac transplantation outcomes in patients with adult congenital heart disease. Heart 103(18):1449–1454

    Article  PubMed  Google Scholar 

  • Moffatt-Bruce SD, Karamichalis J, Robbins RC et al (2006) Are heart-lung transplant recipients protected from developing bronchiolitis obliterans syndrome? Ann Thorac Surg 81:286–291

    Article  PubMed  Google Scholar 

  • Nagpal AD, Chamogergakis TC, Shafii AE et al (2013) Combined heart and liver transplantation: the Cleveland clinic experience. Ann Thorac Surg 95:179–182

    Article  PubMed  Google Scholar 

  • Narula J, Bennett LE, DiSalvo T et al (1996) Outcomes in recipients of combined heart-kidney transplantation: multiorgan, same-donor transplant study of the International Society of Heart and Lung Transplantation/United Network for Organ Sharing Scientific Registry. Transplantation 63(6):861–867

    Article  Google Scholar 

  • Nelson LM, Penninga L, Sander K et al (2013) Long-term outcome in patients treated with combined heart and liver transplantation for familial amyloidotic cardiomyopathy. Clin Transpl 27:203–209

    Article  Google Scholar 

  • Norman JC, Brook MI, Cooley DA et al (1978) Total support of the circulation of a patient with post-cardiotomy stone-heart syndrome by a partial artificial heart (ALVAD) for 5 days followed by heart and kidney transplantation. Lancet 311:1125–1127

    Article  Google Scholar 

  • Ostermann ME, Rogers CA, Saeed I et al (2003) Pre-existing renal failure doubles 30-day mortality after heart transplantation. J Heart Lung Transplant 23:1231–1237

    Article  Google Scholar 

  • Palazzuoli A, Lombardi C, Ruocco G et al (2016) Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact? Eur Heart J Acute Cardiovasc Care 5(8):534–548

    Article  PubMed  Google Scholar 

  • Pasupneti S, Dhillon G, Reitz, et al (2017) Combined heart lung transplantation: an updated review of the current literature. Transplantation. Epub ahead of print

    Google Scholar 

  • Rafat C, Hertig A, Rondeau E (2015) Renal impairment an impediment to heart transplantation? IJKD 9(2):77–83

    PubMed  Google Scholar 

  • Raichlin E, Kushwaha SS, Daly RC et al (2011) Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy. Transplant Proceed 1:1871–1876

    Article  Google Scholar 

  • Ronco C, DI Lullo L (2016) Cardiorenal syndrome in Western countries: epidemiology, diagnosis and management approaches. Kidney Dis 2:151–163

    Article  Google Scholar 

  • Ross HJ, Law Y, Book WM et al (2016) Transplantation and mechanical circulatory support in congenital heart disease: a scientific statement from the American Heart Association. Circulation 133:802–820

    Article  PubMed  Google Scholar 

  • Russo MJ, Rana A, Chen JM et al (2009) Pretransplantation patient characteristics and survival following combined heart and kidney transplantation: an analysis of the united network for organ sharing database. Arch Surg 144(3):241–246

    Article  PubMed  Google Scholar 

  • Samsky MD, Patel CB, Owen A et al (2013) Ten-year experience with extended criteria cardiac transplantation. Circ Heart Fail 6:1230–1238

    Article  PubMed  PubMed Central  Google Scholar 

  • Schaffer JM, Chiu P, Singh SK et al (2014a) Combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure. Am J Transplant 14:384–396

    Article  CAS  PubMed  Google Scholar 

  • Schaffer JM, Chiu P, Singh SK et al (2014b) Combined heart-liver transplantation in the MELD era: do waitlisted patients require exception status? Am J Transplant 14:647–659

    Article  CAS  PubMed  Google Scholar 

  • Sodhi SS, Guo JP, Maurer AH et al (2002) Gastroparesis after combined heart and lung transplantation. J Clin Gastroenterol 34(1):34–39

    Article  CAS  PubMed  Google Scholar 

  • Sulewski ME, Wolf JH, Hasz R et al (2014) Combined heart-liver transplantation; implications for liver-alone wait list mortality. Transplantation 98(5):e45–e47

    Article  PubMed  PubMed Central  Google Scholar 

  • Te HS, Anderson AS, Millis JM et al (2008) Current state of combined heart-liver transplantation in the United States. J Heart Lung Transplant 27(7):753–759

    Article  PubMed  Google Scholar 

  • Topilsky Y, Raichlin E, Hasin T et al (2013) Combined heart and liver transplant attenuates cardiac allograft vasculopathy compared with isolated heart transplant. Transplantation 95(6):859–865

    Article  PubMed  PubMed Central  Google Scholar 

  • Van De Bruanene A, La Gerche A, Claessen G et al (2014) Sildenafil improves exercise hemodynamics in Fontan patients. Circ Cardiovasc Imaging 7:265–273

    Article  Google Scholar 

  • Vermes E, Grimber P, Sebbag L et al (2009) Long-term results of combined heart and kidney transplantation: a French multicenter study. J Heart Lung Transplant 23(5):440–445

    Article  Google Scholar 

  • Waddell TK, Bennett L, Kennedy R et al (2002) Heart-lung or lung transplantation for Eisenmenger syndrome. J Heart Lung Transplant 21(7):731–737

    Article  PubMed  Google Scholar 

  • Weill D, Benden C, Corris PA et al (2015) A consensus document for the selection of lung transplant candidates: 2014 – an update from the Pulmonary Transplantation Council of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 34(1):1–15

    Article  PubMed  Google Scholar 

  • Yanagida R, Czer LSC, Ruzza A et al (2013) Use of ventricular assist device as bridge to simultaneous heart and kidney transplantation in patients with cardiac and renal failure. Transplant Proceed 45:2378–2383

    Article  CAS  Google Scholar 

  • Yusen RD, Christie JD, Edwards LB et al (2013a) The registry of the international society for heart and lung transplantation: thirtieth adult lung and heart-lung transplantation report – 2013; focus theme: age. J Heart Lung Transplant 32(10):965–978

    Article  PubMed  Google Scholar 

  • Yusen RD, Edwards LB, Kucheryavaya AY et al (2013b) The registry of the international society for heart and lung transplantation: thirty-second official adult lung and heart-lung transplantation report – 2015; focus theme: early graft failure. J Heart Lung Transplant 34(10):1264–1277

    Article  Google Scholar 

  • Yusen RD, Edwards LB, Kucheryavaya AY et al (2014) The registry of the international society for heart and lung transplantation: thirty-first adult lung and heart-lung transplantation report – 2014; focus theme: retransplantation. J Heart Lung Transplant 33(10):1009–1024

    Article  PubMed  Google Scholar 

  • Yusen RD, Edwards LB, Dipchand AI et al (2016) The registry of the international society for heart and lung transplantation: thirty-third adult lung and heart-lung transplant report – 2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant 35(10):1170–1184

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Pennsylvania, Philadelphia, PA, USA

    Joyce Wald

Authors
  1. Katherine J. Kunkel
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  2. Maria Molina
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  3. Joyce Wald
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Corresponding author

Correspondence to Joyce Wald .

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Editors and Affiliations

  1. Cardiac, Vascular and Thoracic Surgery, Inova Fairfax Hospital, Falls Church, VA, VA, USA

    Linda Bogar

  2. Heart Failure/Transplant Cardiologist, The Cleveland Clinic Foundation, Cleveland, OH, OH, USA

    Maria Mountis

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Kunkel, K.J., Molina, M., Wald, J. (2019). Combined Heart Transplantation with Other Organ Transplantation. In: Bogar, L., Mountis, M. (eds) Contemporary Heart Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-33280-2_34-1

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  • DOI: https://doi.org/10.1007/978-3-319-33280-2_34-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33280-2

  • Online ISBN: 978-3-319-33280-2

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