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Pagano G, Koshy AN, Chadha R, VanWagner LB, Crespo G. Management of the liver transplant candidate with high cardiac risk: Multidisciplinary best practices and recommendations. Liver Transpl 2024:01445473-990000000-00376. [PMID: 38727607 DOI: 10.1097/lvt.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
In a setting characterized by a growing prevalence of patients with alcohol-associated and metabolic dysfunction-associated steatotic liver diseases, coupled with an aging patient demographic, the incidence of cardiac comorbidities in liver transplant candidates is on the rise. These comorbidities not only pose barriers to transplant eligibility but also impact the intraoperative course and affect posttransplant outcomes. As such, there is a significant need to optimize the clinical management of these cardiac comorbidities. However, there is a scarcity of evidence regarding the best practices for managing cardiac comorbidities such as coronary and valvular heart diseases, arrhythmia, and cardiomyopathy in this population, both before and during transplant surgery. These conditions necessitate a coordinated and multidisciplinary approach to care. In this manuscript, we conduct a comprehensive review of the most recent evidence pertaining to the preoperative and intraoperative management of these cardiac comorbidities in liver transplant candidates. Our aim is to provide recommendations that improve and standardize their clinical care.
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Affiliation(s)
- Giulia Pagano
- Department of Hepatology, Hospital Clínic, Liver Transplant Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Anoop N Koshy
- Department of Cardiology and Victorian Liver Transplant Unit, Austin Health, University of Melbourne, Victoria, Australia
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gonzalo Crespo
- Department of Hepatology, Hospital Clínic, Liver Transplant Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Shingina A, Bansal N, Cedars A, Chen S, Daugherty T, Emamaullee J, Ganger D, Ge J, Heller T, Hughes D, Kay J, Ortega Legaspi J, Menachem J, Montenovo M, Sack J, Reardon L, Schiano T, Simpson K, Teuteberg J, Tompkins R, Vodkin I, Wu F, Lui G, Zaidi AN, Kappus M, Hilscher M. Combined heart liver transplantation in the patients with advanced liver disease and/or hepatocellular carcinoma: Why cannot liver pull the heart? Am J Transplant 2024; 24:503-505. [PMID: 37839708 DOI: 10.1016/j.ajt.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Alexandra Shingina
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, USA
| | - Ari Cedars
- Divisions of Pediatric and Adult Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tami Daugherty
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Juliet Emamaullee
- Liver Transplant Center, Children's Hospital-Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Daniel Ganger
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Jin Ge
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Theo Heller
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Dempsey Hughes
- Division of Gastroenterology and Hepatology, Division of Gastroenterology Veterans Affairs Medical Center, Michigan Medicine University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Kay
- Colorado University School of Medicine, Denver, Colorado, USA
| | - Juan Ortega Legaspi
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan Menachem
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin Montenovo
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan Sack
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Leigh Reardon
- Division of Adult Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Thomas Schiano
- Divisions of Hepatology (T.S.), Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kathleen Simpson
- University of Colorado Denver, Children's Hospital of Colorado, Aurora, CO, USA
| | - Jeffrey Teuteberg
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, California, USA
| | - Rose Tompkins
- The Guerin Family Congenital Heart Program, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irine Vodkin
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Fred Wu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, Massachusetts, USA
| | - George Lui
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA; Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ali N Zaidi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Matthew Kappus
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Moira Hilscher
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Mayo Clinic, USA
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Kobashigawa J, VanWagner LB, Hall S, Emamaullee J, Entwistle JW, Ganger D, Gebel H, Jeevanandam V, Kaldas F, Kilic A, Kittleson M, Kushwaha S, Kwong A, Lui GK, Motayagheni N, Patel J, Patel N, Pereira N, Potter L, Sani M, Schiano TD, Shingina A. Summary of a consensus conference on heart-liver transplantation. Am J Transplant 2024; 24:380-390. [PMID: 38072122 DOI: 10.1016/j.ajt.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/31/2023]
Abstract
Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart failure with associated liver disease from chronic right-sided heart or Fontan failure. However, the criteria for CHLT have not been established. To address this unmet need, a virtual consensus conference was organized on June 10, 2022, endorsed by the American Society of Transplantation. The conference represented a collaborative effort by experts in cardiothoracic and liver transplantation from across the United States to assess interdisciplinary criteria for liver transplantation in the CHLT candidate, surgical considerations of CHLT, current allocation system that generally results in the liver following the heart for CHLT, and optimal post-CHLT management. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical issues related to multiorgan transplantation were also debated. The findings and consensus statements are presented.
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Affiliation(s)
- Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
| | - Lisa B VanWagner
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | - Fady Kaldas
- University of California, Los Angeles, Los Angeles, California, USA
| | - Ahmet Kilic
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | | | | | | | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nikhil Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | | | - Lisa Potter
- University of Chicago, Chicago, Illinois, USA
| | - Maryam Sani
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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Nuqali A, Bellumkonda L. Dual organ transplantation: when heart alone is not enough. Curr Opin Organ Transplant 2023; 28:370-375. [PMID: 37582057 DOI: 10.1097/mot.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW The number of dual organ transplantations (DOT) are steadily increasing over the past few years. This is both a reflection of increasing complexity and advanced disease process in the patients and greater transplant center experience with performing dual organ transplants. Due to lack of standardization of the process, there remains significant center-based variability in patient selection, perioperative and long-term management of these patients. RECENT FINDINGS Overall posttransplant outcomes for DOT have been acceptable with some immunological advantages because of partial tolerance offered by the second organ. These achievements should, however, be balanced with the ethical implications of bypassing the patients who are listed for single organ transplantation because of the preferential allocation of organs for DOT. SUMMARY The field of DOT is expanding rapidly, with good long-term outcomes. There is an urgent need for guidelines to standardize the process of patient selection and listing dual organ transplantation.
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Affiliation(s)
- Abdulelah Nuqali
- Division of Cardiology, Department of Medicine Yale University School of Medicine, New Haven, Connecticut, USA
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