Combined Heart and Liver Transplantation: The Cleveland Clinic Experience

A. Dave Nagpal, MD, Themistokles Chamogeorgakis, MD, Alexis E. Shafii, MD, Mazen Hanna, MD, Charles M. Miller, MD, John Fung, MD, PhD, and Gonzalo V. Gonzalez-Stawinski, MD

Background: Combined heart-liver transplantation (CHLT) has been utilized as a life-saving procedure in those with end-stage cardiac and hepatic pathology.

Techniques and outcomes of this procedure are varied. We sought to review the Cleveland Clinic experience with CHLT.

Methods: This study is a retrospective chart review of patients who received simultaneous heart and liver transplantation between January 2006 and December 2012.

Results: Five patients received CHLT. The mean age was 49 (
20) years. All cardiac pathology was nonischemic cardiomyopathy, with a mean ejection fraction of 0.36 (
0.13). Three of the 5 were on preoperative inotropic support, 1 of which required placement of a total

Operative Technique
Organs were procured from single heart-liver donors. Cardiac procurement consisted of cardioplegia with histidine- tryptophan-ketoglutarate solution (Custodiol HTK, Essential Pharmaceuticals, Newtown, PA) with venting through the inferior vena cava (IVC) and left atrium in Sondergaard’s groove or the left atrial appendage.

Liver allografts were also flushed and preserved with Custodiol HTK using arterial perfusion through an infrarenal aortic cannula.

All patients underwent heart transplantation first.