Combined thoracic-abdominal organ transplants are infrequently performed procedures indicated for patients with failure of two or more transplantable organs. In this review, we discuss recipient selection, surgical considerations, anesthetic management, and outcomes associated with common combinations of thoracic-abdominal transplant operations. General principles regarding the postoperative care of these patients are also discussed. These procedures present a unique challenge requiring specialized knowledge, technical expertise, and leadership from the anesthesiology team throughout the perioperative period.
NormanJCBrookMICooleyDAet al. 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. 1978;1:1125-1127.
2.
StarzlTEBilheimerDWBahnsonHTet al. Heart-liver transplantation in a patient with familial hypercholesterolaemia. Lancet. 1984;1:1382-1383.
3.
CannonRMHughesMGJonesCMEngMMarvinMR.A review of the United States experience with combined heart-liver transplantation. Transpl Int. 2012;25:1223-1228.
4.
BarshesNRDiBardinoDJMcKenzieEDet al. Combined lung and liver transplantation: the United States experience. Transplantation. 2005;80:1161-1167.
5.
KilicAGrimmJCWhitmanGJet al. The survival benefit of simultaneous heart-kidney transplantation extends beyond dialysis-dependent patients. Ann Thorac Surg. 2015;99:1321-1327.
6.
HeywoodJTFonarowGCCostanzoMRMathurVSWigneswaranJRWynneJ; ADHERE Scientific Advisory Committee and Investigators. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail. 2007;13:422-430.
7.
VerbruggeFHGrietenLMullensW.Management of the cardiorenal syndrome in decompensated heart failure. Cardiorenal Med. 2014;4:176-188.
8.
RuzzaACzerLSTrentoAEsmailianF.Combined heart and kidney transplantation: what is the appropriate surgical sequence?Interact Cardiovasc Thorac Surg. 2013;17:416-418.
9.
MehraMRCanterCEHannanMMet al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35:1-23.
10.
RussoMJRanaAChenJMet al. Pretransplantation patient characteristics and survival following combined heart and kidney transplantation: an analysis of the United Network for Organ Sharing Database. Arch Surg. 2009;144:241-246.
11.
ReichHDimbilSLevineRet al. Dual-organ transplantation in older recipients: outcomes after heart-kidney transplant versus isolated heart transplant in patients aged ≥65 years. Interact Cardiovasc Thorac Surg. 2019;28:45-51.
12.
HermsenJLNathDSdel RioAMet al. Combined heart-kidney transplantation: the University of Wisconsin experience. J Heart Lung Transplant. 2007;26:1119-1126.
13.
GillJShahTHristeaIet al. Outcomes of simultaneous heart-kidney transplant in the US: a retrospective analysis using OPTN/UNOS data. Am J Transplant. 2009;9:844-852.
14.
RanaARoblesSRussoMJet al. The combined organ effect: protection against rejection?Ann Surg. 2008;248:871-879.
15.
Mc LoughlinSBiancoJCMarenchinoRG.Anesthetic and perioperative considerations for combined heart-kidney transplantation. J Cardiothorac Vasc Anesth. 2018;32:44-49.
16.
GordonACMasonAJThirunavukkarasuNet al; VANISH Investigators. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. 2016;316:509-518.
17.
PatelSRD’alessandroDShinJJ.Combined heart and liver transplantation in an adult with familial heterozygous hypercholesterolemia and severe ischemic cardiomyopathy. J Heart Lung Transplant. 2012;31:229.
18.
RobinsonMRAl-KindiSGOliveiraGH.Heart and heart-liver transplantation in patients with hemochromatosis. Int J Cardiol. 2017;244:226-228.
19.
BryantR3rdRizwanRZafarFet al. Contemporary outcomes of combined heart-liver transplant in patients with congenital heart disease. Transplantation. 2018;102:e67-e73.
20.
EleborgLSuhrOGunnarssonL.Familial amyloidotic polyneuropathy (FAP) = cardiac and circulatory function during anesthesia for liver transplantation. Amyloid. 1997;4:24-32.
BealEWMumtazKHayesDJrWhitsonBABlackSM.Combined heart-liver transplantation: indications, outcomes and current experience. Transplant Rev (Orlando). 2016;30:261-268.
23.
DalyRCTopilskyYJoyceLet al. Combined heart and liver transplantation: protection of the cardiac graft from antibody rejection by initial liver implantation. Transplantation. 2013;95:e2-e4.
24.
BernierPLGrenonMErginaPet al. Combined simultaneous heart and liver transplantation with complete cardiopulmonary bypass support. Ann Thorac Surg. 2007;83:1544-1545.
25.
CouetilJPAHoussinDPSoubraneOet al. Combined lung and liver transplantation in patients with cystic fibrosis. A 4 1/2-year experience. J Thorac Cardiovasc Surg. 1995;110:1415-1423.
26.
WeillDBendenCCorrisPAet al. A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34:1-15.
27.
MorerLChoudatLDauriatGet al. Liver involvement in patients with Pi ZZ-emphysema, candidates for lung transplantation. Am J Transplant. 2017;17:1389-1395.
28.
YiSGLunsfordKEBruceCGhobrialRM.Conquering combined thoracic organ and liver transplantation: indications and outcomes for heart-liver and lung-liver transplantation. Curr Opin Organ Transplant. 2018;23:180-186.
29.
StephanieGYBurroughsSGLoebeMet al. Combined lung and liver transplantation: analysis of a single-center experience. Liver Transpl. 2014;20:46-53.
30.
AldenkorttFAldenkorttMCaviezelLWaeberJLWeberASchifferE.Portopulmonary hypertension and hepatopulmonary syndrome. World J Gastroenterol. 2014;20:8072-8081.
31.
WadeiHMMaiMLAhsanNGonwaTA.Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1:1066-1079.
32.
GrannasGNeippMHoeperMMet al. Indications for and outcomes after combined lung and liver transplantation: a single-center experience on 13 consecutive cases. Transplantation. 2008;85:524-531.
33.
Dell’AmoreABottaLGallieriSArpesellaG.Extracorporeal membrane oxygenator assistance as “bridge” to combined heart and liver transplantation. Transplant Proc. 2006;38:3004-3005.
34.
MarkmannJGhobrialMMaglioccaJDemetrisAAbouljoudM. Results of the Initial Phase of the Portable Organ Care System (OCS™) Liver PROTECT Pivotal Trial. Paper presented at: 2017 American Transplant Congress; May 1, 2017; Chicago, IL. Abstract Number: 279.
35.
SalmanJGrannasGIusFet al. The liver-first approach for combined lung and liver transplantation. Eur J Cardiothorac Surg. 2018;54:1122-1127.
36.
AdamsBChiemDWangCNeelankavilJ.Combined bilateral lung-liver transplantation complicated by intraoperative right ventricular dysfunction and postoperative hepatic artery thrombosis. J Cardiothorac Vasc Anesth. 2013;27:1343-1346.
37.
SimschOGromannTKnosallaCHüblerMHetzerRLehmkuhlH.The intensive care management of patients following heart transplantation at the Deutsches Herzzen-trum Berlin. Appl Cardiopulm Pathophysiol. 2011;15:230-240.
38.
SuzukiYCantuEChristieJD.Primary graft dysfunction. Semin Respir Crit Care Med. 2013;34:305-319.
39.
FeltraccoPBarbieriSGalligioniHMichielettoECarolloCOriC.Intensive care management of liver transplanted patients. World J Hepatol. 2011;3:61-71.
40.
GoldbergDSReesePPAmaralSAbtPL.Reframing the impact of combined heart-liver allocation on liver transplant wait-list candidates. Liver Transpl. 2014;20:1356-1364.
41.
WolfJHSulewskiMECassutoJRet al. Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient?Am J Transplant. 2013;13:1806-1816.
