ArticleWorld journal of transplantation2025
Outcomes and complications of combined heart-liver transplantation in patients with failing Fontan physiology: A systematic review.
Article in World journal of transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSingle-ventricle congenital heart disease often requires the Fontan procedure, which can lead to Fontan-associated liver disease (FALD) and multi-organ failure. Combined heart-liver transplantation (CHLT) is a potential lifesaving option for these patients.
aimTo investigate the outcomes and complications of CHLT in patients with failing Fontan physiology.
methodsSeven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessed with the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals.
resultsThe pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%, respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Mean ischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renal replacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopic heart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30,
conclusionCHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Future prospective studies are warranted to refine eligibility and improve long-term survival.
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