Nandkeolyar Shuktika, Gupta Tripti, Brinkley D Marshall, Alexopoulos Sophoclis, Firsich Emily, Fossey Sally Anne, Fowler Rachel, Frischhertz Benjamin, Harrison Kimberly, Lindenfeld JoAnn, Montenovo Martin, Pedrotty Dawn, Punnoose Lynn, Rali Aniket, Shingina Alexandra, Schlendorf Kelly, Siddiqi Hasan, Shah Ashish, Zalawadiya Sandip, Wigger Mark, Menachem Jonathan N
Division of Cardiology, Atrium Healthcare, Charlotte, NC, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Int J Cardiol Congenit Heart Dis. 2024 Feb 28;15:100504. doi: 10.1016/j.ijcchd.2024.100504. eCollection 2024 Mar.
Each year the number of combined heart-liver transplants (HLT) increases, with two distinct patient populations proceeding down this pathway. The first are patients with congenital heart disease (CHD), most commonly single ventricle patients palliated with Fontan. The second group are those with long standing congestive hepatopathy, amyloidosis, hemochromatosis, or alcohol induced myopathies and liver disease.One argument for HLT has been the low rate of rejection even among sensitized patients, with reported rejection rates ranging from 0% to 31%. Historically, those with CHD have been highly sensitized which in some cases may prevent or at least delay transplantation. As such, a recent consensus statement by Emamaulee et al. suggest that "there may be an immunological benefit to proceed with HLT with significantly fewer acute cellular and humoral rejection episodes". The aim of this study is to demonstrate that HLT patients remain at risk for rejection and have required treatment for it.
There were 15 patients who underwent HLT from January 2017 to February 2022. Of the four patients who did not have CHD, none were considered sensitized, and all underwent induction with basiliximab per our institutional protocol. One of these had rejection. Rejection episodes were identified in four of the 11 CHD patients (36%) patients.
In our study of 15 HLT, including 11 CHD patients (73% denied transplant at ≥ 1 center) demonstrated a higher rate of rejection than previously reported. While theoretically, HLT may mitigate the likelihood of rejection, the risk still exists, and patients benefit from close monitoring commensurate with single organ transplant.
每年心脏肝脏联合移植（HLT）的数量都在增加，有两类不同的患者群体选择了这条治疗途径。第一类是患有先天性心脏病（CHD）的患者，最常见的是接受Fontan姑息治疗的单心室患者。第二类是患有长期充血性肝病、淀粉样变性、血色素沉着症或酒精性肌病和肝病的患者。支持心脏肝脏联合移植的一个理由是，即使在致敏患者中，排斥反应的发生率也很低，报告的排斥反应发生率在0%至31%之间。从历史上看，患有先天性心脏病的患者致敏程度很高，在某些情况下可能会阻止或至少延迟移植。因此，Emamaulee等人最近的一份共识声明表明，“进行心脏肝脏联合移植可能有免疫学益处，急性细胞和体液排斥反应明显减少”。本研究的目的是证明心脏肝脏联合移植患者仍有排斥反应的风险，并且需要为此进行治疗。
2017年1月至2022年2月期间有15名患者接受了心脏肝脏联合移植。在4名没有先天性心脏病的患者中，没有人被认为是致敏的，并且根据我们的机构方案，所有患者都接受了巴利昔单抗诱导治疗。其中1人发生了排斥反应。在11名先天性心脏病患者中有4人（36%）出现了排斥反应。
在我们对15例心脏肝脏联合移植的研究中，包括11名先天性心脏病患者（73%在≥1个中心被拒绝移植），排斥反应发生率高于先前报道。虽然从理论上讲，心脏肝脏联合移植可能会降低排斥反应的可能性，但风险仍然存在，患者受益于与单器官移植相当的密切监测。
