The Current State of Simultaneous Heart Liver Transplantation in the United States.

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation Pub Date : 2025-07-05 DOI:10.1016/j.ajt.2025.07.001

Ahmad Anouti,Ali H Dakroub,Hussein Krayem,Lauren E Matevish,Hamza Dahshi,Sara Hassan,Arjmand R Mufti,Parsia A Vagefi,Maryjane Farr,Matthias Peltz,Lisa B VanWagner,Thomas G Cotter,William M Lee,Madhukar S Patel

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引用次数: 0

Abstract

Simultaneous heart liver transplantation (SHLT) has expanded in recent years, bolstered by increases in congenital heart disease (CHD) indications and improvements in organ preservation. We performed a contemporary analysis of patients undergoing SHLT for CHD vs non-CHD, further exploring the impact of machine perfusion (MP). Patients undergoing SHLT between 2010-2024 were retrospectively identified using the UNOS database, assessing a primary outcome of patient survival and secondary outcome of MP utilization. 535 patients underwent SHLT, 224(41.9%) with CHD indication and 311(58.1%) non-CHD. CHD recipients had significantly lower one-(72.9% vs. 89.4%,p<0.01) and five-year survival (66.1% vs. 81.4%,p<0.01) compared to non-CHD recipients. CHD indication was independently associated with a two-fold increased mortality risk, compared to a non-CHD diagnosis (HR:2.31, 95%CI:[1.53,3.47]). Decision tree boosting demonstrated a 2.9% higher relative mortality likelihood after SHLT for recipients with CHD. From 2022-2024, SHLT MP utilization for CHD increased; among 111 patients, 18.0% received a MP liver, 8.1% a MP heart, and 10.8% MP heart and MP liver. In this analysis of modern SHLT cases, patients with CHD had suboptimal outcomes; several donor and recipient factors also impacted mortality. Awareness of these factors can guide pre-transplant optimization, donor/recipient matching, and strategic MP use to improve survival.

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美国同步心肝移植的现状。

近年来，由于先天性心脏病（CHD）适应症的增加和器官保存的改善，同步心肝移植（SHLT）已经扩大。我们对冠心病和非冠心病患者进行了SHLT的当代分析，进一步探讨了机器灌注（MP）的影响。使用UNOS数据库对2010-2024年间接受SHLT的患者进行回顾性分析，评估患者生存的主要结局和MP使用的次要结局。535例患者接受了SHLT， 224例（41.9%）伴有冠心病，311例（58.1%）无冠心病。与非冠心病患者相比，冠心病患者的生存率（72.9% vs. 89.4%,p<0.01）和5年生存率（66.1% vs. 81.4%,p<0.01）显著降低。与非冠心病诊断相比，冠心病适应症与死亡风险增加两倍独立相关（HR:2.31, 95%CI:[1.53,3.47]）。决策树增强显示冠心病患者SHLT后的相对死亡率提高2.9%。2022-2024年CHD的SHLT MP利用率增加；在111例患者中，18.0%接受了MP肝脏移植，8.1%接受了MP心脏移植，10.8%接受了MP心脏和MP肝脏移植。在对现代SHLT病例的分析中，冠心病患者的预后不理想；几个供体和受体因素也影响死亡率。了解这些因素可以指导移植前优化、供体/受体匹配和策略性地使用MP来提高生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Transplantation 医学-外科

CiteScore

18.70

自引率

4.50%

发文量

346

审稿时长

26 days

期刊介绍： The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.