Implantation of the Liver During Reperfusion of the Heart in Combined Heart-Liver Transplantation: Own Experience and Review of the Literature

Background. There are only a few reports about combined heart-liver transplantations. The surgical techniques differ widely, ranging from sequential implantation of the organs to simultaneous transplantations. We report our experience with simultaneous, combined heart-liver transplantations without using a veno-venous bypass demonstrating that this is a feasible surgical technique. Methods. Since 2005, we performed 4 combined heart-liver transplantations by implanting the liver during the reperfusion period of the newly implanted heart. We retrospectively reviewed patient clinical data and outcomes. Results. The mean operative time was 534 +/- 247 minutes and the ischemia times for heart and liver were 190 +/- 72 minutes (cold ischemia time for the heart), 98 +/- 96 minutes (warm ischemia time for the heart), 349 +/- 101 minutes (cold ischemia time for the liver), and 36.25 +/- 3.5 minutes (warm ischemia time for the liver). Three patients were discharged from the hospital after an uneventful clinical course. One patient died due to multi-organ failure during the intensive care unit stay on the 23rd postoperative day. Conclusion. We suggest that combined, simultaneous heart-liver transplantation without veno-venous bypass is a feasible surgical technique.