Student and Faculty Publications
Publication Date
2-1-2024
Journal
Transplantation Direct
Abstract
Advances in surgical technique and multidisciplinary management have improved long-term survival for patients born with single ventricle physiology. However, patients who have undergone Fontan completion remain at risk for long-term comorbidities associated with the complex hemodynamic changes following the procedure, including Fontan failure and Fontan-associated liver disease.1 Combined heart-liver transplantation (CHLT) is a rare but lifesaving procedure that has been described in the setting of heart and liver failure secondary to Fontan failure.2 As long-term survival continues to improve for Fontan patients, the incidence of Fontan-associated liver disease will increase. Thus, improving CHLT outcomes and access to both organs is a strong priority.
Here, we describe a successful CHLT for a patient with chronic ventricular dysfunction and Fontan-associated liver disease. The key innovation in this case was the use of normothermic machine perfusion (NMP) to preserve both the heart and liver grafts. This approach extended the preservation time for the liver while also mitigating the risk of ischemic injury and reducing the time pressure constraints on the heart transplant team. Notably, this stands in contrast to traditional static cold storage (SCS), where metabolic activity is reduced through hypothermia, but the extended cold ischemic time can lead to increased vulnerability to reperfusion injury.
Comments
PMID: 38274477