Summary of a consensus conference on heart-liver transplantation

Jon Kobashigawa; Lisa B VanWagner; Shelley Hall; Juliet Emamaullee; John W Entwistle; Daniel Ganger; Howard Gebel; Valluvan Jeevanandam; Fady Kaldas; Ahmet Kilic; Michelle Kittleson; Sudhir Kushwaha; Allison Kwong; George K Lui; Negar Motayagheni; Jignesh Patel; Nikhil Patel; Naveen Pereira; Lisa Potter; Maryam Sani; Thomas D Schiano; Alexandra Shingina; Consensus Conference participants

doi:10.1016/j.ajt.2023.12.002

Summary of a consensus conference on heart-liver transplantation

Am J Transplant. 2024 Mar;24(3):380-390. doi: 10.1016/j.ajt.2023.12.002. Epub 2023 Dec 9.

Authors

Jon Kobashigawa¹, Lisa B VanWagner², Shelley Hall³, Juliet Emamaullee⁴, John W Entwistle⁵, Daniel Ganger⁶, Howard Gebel⁷, Valluvan Jeevanandam⁸, Fady Kaldas⁹, Ahmet Kilic¹⁰, Michelle Kittleson¹¹, Sudhir Kushwaha¹², Allison Kwong¹³, George K Lui¹³, Negar Motayagheni¹¹, Jignesh Patel¹¹, Nikhil Patel¹¹, Naveen Pereira¹², Lisa Potter⁸, Maryam Sani¹¹, Thomas D Schiano¹⁴, Alexandra Shingina¹⁵; Consensus Conference participants

Collaborators

Consensus Conference participants:
Jon Kobashigawa¹⁶, Lisa B VanWagner¹⁷, Shelley Hall¹⁸, Abbas Ardehali¹⁹, David Baran²⁰, Arvind Bhimaraj²¹, Clark Andrew Bonham²², Joao Roberto Breda²³, Sharon Chen²², Lawrence Czer¹⁶, David D' Alessandro²⁴, Tami Daugherty²², Teresa De Marco²⁵, Juliet Emamaullee²⁶, Dominic Emerson¹⁶, John W Entwistle²⁷, Fardad Esmailian¹⁶, Jerry Estep²⁸, Osama Gaber²¹, Daniel Ganger²⁹, Howard Gebel³⁰, Noelle Hanako Ebel²², Carla Harmath³¹, Julie Heimbach³², Manhal Izzy³³, Annette Jackson³⁴, Val Jeevanandam³¹, Jeffrey Kahn²⁶, Fady Kaldas³⁵, Patrick Kamath³², Ahmet Kilic³⁶, Michelle Kittleson¹⁶, Alex Kuo³⁷, Sudhir Kushwaha³², Allison Kwong²², Matthew Lewis³⁸, Matthias Loebe³⁹, George Lui²², Joren Madsen²⁴, Rhondalyn McLean⁴⁰, Jonathan Menachem⁴¹, Constance Mobley²¹, Arji Mufti⁴², Jignesh Patel¹⁶, Naveen Pereira³², Sean Pinney³¹, Lisa Potter³¹, Jordan Sack⁴³, Amandeep Sahota⁴⁴, Thomas D Schiano⁴⁵, Kelly Schlendorf⁴¹, Alexandra Shingina⁴¹, Koji Takeda³⁸, Timucin Taner³², Helen Te³¹, Jeffrey Teuteberg²², Rose Tompkins¹⁶, Betsy Verna⁴⁶, Anji Wall⁴⁷

Affiliations

¹ Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA. Electronic address: Kobashigawaj@cshs.org.
² University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ Baylor University Medical Center, Dallas, Texas, USA.
⁴ University of Southern California, Los Angeles, California, USA.
⁵ Jefferson University, Philadelphia, Pennsylvania.
⁶ Northwestern University, Chicago, Illinois, USA.
⁷ Emory University, Atlanta, Georgia, USA.
⁸ University of Chicago, Chicago, Illinois, USA.
⁹ University of California, Los Angeles, Los Angeles, California, USA.
¹⁰ Johns Hopkins Hospital, Baltimore, Maryland, USA.
¹¹ Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
¹² Mayo Clinic, Rochester, Minnesota.
¹³ Stanford University, Stanford, California, USA.
¹⁴ The Mount Sinai Medical Center, New York, New York.
¹⁵ Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁶ Cedars-Sinai Smidt Heart Institute, Los Angeles, CA.
¹⁷ University of Texas Southwestern, Dallas, TX.
¹⁸ Baylor University Medical Center, Dallas, TX.
¹⁹ UCLA, Los Angeles, CA.
²⁰ Sentara Heart Hospital, Eastern Virginia Medical School, Norfolk, VA.
²¹ Houston Methodist Hospital, Houston, TX.
²² Stanford University, Stanford, CA.
²³ University of Miami Miller School of Medicine, Miami, FL.
²⁴ Massachusetts General Hospital, Boston, MA.
²⁵ University of California San Francisco, San Francisco, CA.
²⁶ University of Southern California, Los Angeles, CA.
²⁷ Thomas Jefferson University, Philadelphia, PA.
²⁸ Cleveland Clinic, Cleveland, OH.
²⁹ Northwestern University, Chicago, IL.
³⁰ Emory University, Atlanta, GA.
³¹ University of Chicago, Chicago, IL.
³² Mayo Clinic, Rochester, MN.
³³ Vanderbilt, Nashville, TN.
³⁴ Duke University, Durham, NC.
³⁵ University of California at Los Angeles, Los Angeles, CA.
³⁶ Johns Hopkins, Baltimore, MD.
³⁷ Cedars-Sinai Medical Center, Los Angeles, CA.
³⁸ Columbia University, New York, NY.
³⁹ Jackson Memorial, Miami, FL.
⁴⁰ University of Pennsylvania, Philadelphia, PA.
⁴¹ Vanderbilt University, Nashville, TN.
⁴² UT Southwestern, Dallas, TX.
⁴³ Brigham and Women's Hospital, Boston, MA.
⁴⁴ Kaiser Permanente Southern California, Los Angeles, CA.
⁴⁵ The Mount Sinai School of Medicine, New York, NY.
⁴⁶ Columbia/Cornell University, New York, NY.
⁴⁷ Baylor University Medical Science, Dallas, TX.

PMID: 38072122
DOI: 10.1016/j.ajt.2023.12.002

Abstract

Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart failure with associated liver disease from chronic right-sided heart or Fontan failure. However, the criteria for CHLT have not been established. To address this unmet need, a virtual consensus conference was organized on June 10, 2022, endorsed by the American Society of Transplantation. The conference represented a collaborative effort by experts in cardiothoracic and liver transplantation from across the United States to assess interdisciplinary criteria for liver transplantation in the CHLT candidate, surgical considerations of CHLT, current allocation system that generally results in the liver following the heart for CHLT, and optimal post-CHLT management. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical issues related to multiorgan transplantation were also debated. The findings and consensus statements are presented.

Keywords: criteria; heart transplantation; liver transplantation; outcomes.

MeSH terms

Heart
Heart Transplantation*
Humans
Liver Diseases*
Liver Transplantation*