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Choi, Yun, Jung, Lee, Song, Lee, Kim, and Kim: Combined Heart and Liver Transplantation: The Asan Medical Center Experience
Case Report

J Korean Soc Transplant 2017;31(2):91-98.

Published online: 19 January 2017

DOI: https://doi.org/10.4285/jkstn.2017.31.2.91

Combined Heart and Liver Transplantation: The Asan Medical Center Experience

Hyo-In Choi, M.D.1, Tae-Jin Yun, M.D.2, Sung-Ho Jung, M.D.2, Jae Won Lee, M.D.2, Gi-Won Song, M.D.3, Sung-Gyu Lee, M.D.3, Kyung Mo Kim, M.D.4, Jae-Joong Kim, M.D.1,

1Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

2Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

3Division of Liver Transplantation and Hepato-Biliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

4Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Jae-Joong Kim Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3154, Fax: 82-2-486-5918 E-mail: jjkim@amc.seoul.kr

Received 1 February 2017       Revised 2 May 2017       Accepted 6 June 2017

Copyright © the Korean Society for Transplantation, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Combined heart-liver transplantation (CHLT) is an increasingly accepted treatment for select patients with advanced heart and liver disease. However, CHLT are infrequently performed, despite growing optimism about their effectiveness. Here, we report Asan Medical Center experience with CHLT in three patients presenting with advanced heart and liver failure. One patient died of brain swelling because of intractable hyperammonemia on postoperative day 9. The two other patients were still alive at 53 and 9 months postsurgery. None of these patients required readmission for cardiac or hepatic graft dysfunction and no rejection episodes were detected on routine cardiac biopsies. This is the first report of CHLT cases from Korea.

Keywords: Heart transplantation, Liver transplantation, Multi-organ transplant, End-stage heart disease

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Table 1.
Main preoperative parameters of the three combined heart and liver recipients
Parameter Case 1 Case 2 Case 3
Age (yr) 14 45 46
Sex Female Male Male
BMI (kg/m2) 21.7 19.4 21.8
Indication for HT CHF CHF HCMP
Indication for LT Wilson disease Hepatitis B cirrhosis Ischemic hepatopathy combined with toxic hepatitis
Creatinine (mg/dL) 0.6 2.1 1.0
Hemodialysis Yes Yes Yes
PT (INR) 3.8 2.0 1.5
Total bilirubin (mg/dL) 22.1 24.9 24.0
AST (IU/L) 1,449 125 23
ALT (IU/L) 312 49 19
MELD at transplant 40 40 37
ECMO support at registration Yes Yes No
Ventilator support at registration Yes Yes Yes
Inotropic support at registration Yes Yes Yes

Abbreviations: BMI, body mass index; HT, heart transplantation; CHF, congestive heart failure; HCMP, hypertrophic cardiomyopathy; LT, liver transplantation; PT, prothrombin time; INR, international normalized ratio; AST, aspartate aminotransferase; ALT, alanine transaminase; MELD, model for end-stage liver disease; ECMO, extracorporeal membrane oxygenation.

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