Raichlin Eugenia, Daly Richard C, Rosen Charles B, McGregor Christopher G, Charlton Michael R, Frantz Robert P, Clavell Alfredo L, Rodeheffer Richard J, Pereira Naveen L, Kremers Walter K, Kushwaha Sudhir S, Edwards Brooks S
William J. Von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA.
Transplantation. 2009 Jul 27;88(2):219-25. doi: 10.1097/TP.0b013e3181ac60db.
Simultaneous combined orthotopic heart and liver transplantation (CHLTx) remains a lifesaving procedure for the patients suffering from coincident end-stage heart and liver disease and several metabolic disorders. We analyze the long-term outcome of the patients undergoing CHLTx.
Between January 1992 and May 2007, 15 CHLTx were attempted at the Mayo Clinic including two combined heart, liver, and kidney transplantations and one combined heart, lung, and liver transplantations. Pretransplant cardiac diagnoses were familial amyloidosis (11), hemochromatosis (1), restrictive cardiomyopathy and cardiac cirrhosis (1), previously operated congenital heart disease and cardiac cirrhosis (1), and primary pulmonary hypertension with primary biliary cirrhosis (1).
Heart and liver transplantation were performed as a single combined procedure in 13 (93%) hemodynamically stable patients, and there was no perioperative mortality. Survival rates for the CHLTx recipients at 1 year, 5 years, and 10 years were 100%, 75%, and 60%, respectively, and did not differ from survival after isolated heart transplantation (93%, 83%, and 65%, respectively, P=0.39). Freedom from cardiac allograft rejection (ISHLT > or =grade 2) for CHLTx was 83% at 1 month, did not change with time, and was lower than after isolated heart transplantation (P=0.02). At the mean follow-up of 61.6+/-53.6 months, normal left ventricular ejection fraction and good liver allograft function were demonstrated. Three patients developed end-stage renal failure secondary to calcineurin nephrotoxicity.
Simultaneous heart and liver transplantation is feasible and achieved excellent results for selected patients.
同期原位心脏和肝脏联合移植（CHLTx）对于患有终末期心脏和肝脏疾病以及多种代谢紊乱的患者而言，仍然是一种挽救生命的手术。我们分析了接受CHLTx患者的长期预后。
1992年1月至2007年5月期间，梅奥诊所尝试进行了15例CHLTx，其中包括2例心脏、肝脏和肾脏联合移植以及1例心脏、肺和肝脏联合移植。移植前的心脏诊断包括家族性淀粉样变性（11例）、血色素沉着症（1例）、限制性心肌病和心脏肝硬化（1例）、既往接受过手术的先天性心脏病和心脏肝硬化（1例）以及原发性肺动脉高压合并原发性胆汁性肝硬化（1例）。
13例（93%）血流动力学稳定的患者接受了心脏和肝脏联合移植手术，围手术期无死亡病例。CHLTx受者1年、5年和10年的生存率分别为100%、75%和60%，与单纯心脏移植后的生存率（分别为93%、83%和65%，P = 0.39）无差异。CHLTx患者术后1个月心脏移植排斥反应（国际心脏和肺移植学会≥2级）的发生率为83%，且随时间无变化，低于单纯心脏移植（P = 0.02）。平均随访61.6±53.6个月时，左心室射血分数正常，肝脏移植功能良好。3例患者因钙调神经磷酸酶肾毒性继发终末期肾衰竭。
同期心脏和肝脏移植对于特定患者是可行的，且取得了良好的效果。
