Combined heart and liver transplantation: an updated systematic review

• Published in: Annals of the Royal College of Surgeons of England Vol. 104; no. 2; pp. 88 - 94
• Main Authors: Frountzas, M, Karampetsou, N, Nikolaou, C, Schizas, D, Tsapralis, D, Avgerinos, D, Toutouzas, K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-02-2022; Royal College of Surgeons
• Subjects: Amyloidosis; Blood; Cardiomyopathy; Cardiopulmonary Bypass; Cardiovascular disease; Congenital diseases; Heart failure; Heart surgery; Heart Transplantation - methods; Humans; Infections; Ischemia; Length of Stay; Liver; Liver cirrhosis; Liver Transplantation - methods; Liver transplants; Meta-analysis; Mortality; Observational studies; Postoperative period; Review; Systematic review; Transplants & implants; Ventilators; United States > US; Heart; Transplantation; Combined; Liver; Meta-analysis
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2021.0103

Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT.
The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,
SCOPUS,
ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases.
Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration.
Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.