Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Curr Opin Organ Transplant. 2023 Apr 1;28(2):104-109. doi: 10.1097/MOT.0000000000001041. Epub 2022 Dec 1.
Combined heart and liver transplantation (CHLT) is an uncommon but increasingly performed procedure with rising need as the population who has undergone Fontan palliation for single ventricle physiology grows. This article reviews the current literature to summarize what is known about patient selection and outcomes and highlights the questions that remain.
Congenital heart disease (CHD) with Fontan-associated liver disease (FALD) has surpassed noncongenital heart disease as the most common indication for CHLT. In patients with failing Fontan physiology, accurate assessment of recoverability of liver injury remains challenging and requires multifaceted evaluation to determine who would benefit from isolated versus dual organ transplantation. Patient survival has improved over time without significant differences between those with and without a diagnosis of CHD. En bloc surgical technique and best use of intraoperative mechanical circulatory support are topics of interest as the field continues to evolve.
A more refined understanding of appropriate patient selection and indication-specific outcomes will develop as we gain more experience with this complex operation and perform prospective, randomized studies.
心脏和肝脏联合移植（CHLT）是一种不常见但越来越常见的手术，随着接受单心室生理 Fontan 姑息治疗的人群的增加，这种手术的需求也在增加。本文综述了目前的文献，总结了已知的患者选择和结果，并强调了仍然存在的问题。
Fontan 相关肝病（FALD）合并先天性心脏病（CHD）已超过非先天性心脏病成为 CHLT 的最常见指征。在 Fontan 生理功能衰竭的患者中，准确评估肝损伤的可恢复性仍然具有挑战性，需要进行多方面的评估，以确定哪些患者受益于单独或双器官移植。随着时间的推移，患者的生存率有所提高，而患有和不患有 CHD 的患者之间没有显著差异。整块手术技术和术中机械循环支持的最佳利用是该领域不断发展的关注话题。
随着我们在这种复杂手术中获得更多经验并进行前瞻性、随机研究，对合适患者选择和特定适应证结果的更深入了解将不断发展。
