• Nicolas A Brozzi, Matthias Loebe, Fouad Ghazi Souki, Thiago Beduschi, Ali Ghodzisad, Akin Tekin, Ramona Nicolau-Raducu, and Rodrigo M Vianna.
• Division of Thoracic Transplantation and Mechanical Circulatory Support, Miami Transplant Institute, Miami, FL.
• Ann. Surg. 2021 Dec 1; 274 (6): e1284-e1289.

IntroductionComplexity of combined heart-liver transplantation has resulted in low adoption rates. We report a case series of adult patients receiving en-bloc heart-liver transplantation (HLTx), describe technical aspects, and discuss benefits of the technique.MethodsRetrospective review of patients receiving en-bloc HLTx over 18 months, with clinical follow up to 1 year. Primary outcomes included postoperative mortality and major complications. Secondary outcomes included 1-year survival, cardiac or hepatic allograft rejection, and infection.ResultsFive patients received en-bloc HLTx. Mean recipient age was 43 years (26-63), and 3 patients were male. Total operative time was 430 minutes (393-480), cold and warm ischemic times of 85 (32-136) and 37.5 (31-47) minutes. Hospital survival was 80%. One patient died on postoperative day 55 due to fungal sepsis. Major postoperative complications included prolonged mechanical ventilation in 2 of 5 patients (40%), and renal insufficiency requiring hemodialysis in 2 of 5 patients (40%). Among patients discharged from hospital 1-year survival was 100%, with no evidence of rejection or infectious complications.ConclusionEn-bloc HLTx technique is a safe and effective strategy, decreasing operative times, and allograft ischemic times, whereas offering protection of implanted allografts during early stages of reperfusion while patient is hemodynamically supported on cardiopulmonary bypass.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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