• Chase J Wehrle, Andrea Schlegel, Mazhar Khalil, Daniel Rotroff, Luca Del Prete, Marianna Maspero, Roma Raj, William C Frankel, Bijan Eghtesad, Federico Aucejo, Masato Fujiki, Choon David Kwon, Jaekeun Kim, TongMichael Z YMZYHeart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH., Shinya Unai, Jacek Cywinski, Jamak Modaresi Esfeh, Maan Fares, Alejandro Pita, Charles Miller, Cristiano Quintini, Koji Hashimoto, and Teresa Diago-Uso.
• Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
• Ann. Surg. 2023 Dec 5.

ObjectiveWe aim to report our institutional outcomes of single-staged combined liver transplantation (LT) and cardiac surgery (CS).Summary Background DataConcurrent LT and CS is a potential treatment for combined cardiac dysfunction and end-stage liver disease, yet only 54 cases have been previously reported in the literature. Thus, the outcomes of this approach are relatively unknown, and this approach has been previously regarded as extremely risky.MethodsThirty-one patients at our institution underwent combined cardiac surgery and liver transplant. Patients with at least one-year follow-up were included. The Leave-One-Out Cross-Validation (LOOCV) machine-learning approach was used to generate a model for mortality.ResultsMedian follow-up was 8.2 years (IQR 4.6-13.6 y). One- and five-year survival was 74.2% (N=23) and 55% (N=17), respectively. Negative predictive factors of survival included recipient age>60 years (P=0.036), NASH-cirrhosis (P=0.031), Coronary Artery Bypass-Graft (CABG)-based CS (P=0.046) and pre-operative renal dysfunction (P=0.024). The final model demonstrated that renal dysfunction had a relative weighted impact of 3.2 versus CABG (1.7), age ≥60y (1.7) or NASH (1.3). Elevated LT+CS risk score was associated with an increased five-year mortality after surgery (AUC=0.731, P=<0.001). Conversely, the widely accepted STS-PROM calculator was unable to successfully stratify patients according to 1- (P>0.99) or 5-year (P=0.695) survival rates.ConclusionsThis is the largest series describing combined LT+CS, with joint surgical management appearing feasible in highly selected patients. CABG and pre-operative renal dysfunction are important negative predictors of mortality. The four-variable LT+CS score may help predict patients at high risk for post-operative mortality.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

11 keywords...

hide…