Identifying Predictors of Outcomes in Combined Heart and Liver Transplantation.

Background: Combined heart and liver transplant (CHLT) is a complex procedure that is being increasingly performed. Because of the relative rarity of this procedure, graft and patient outcomes are still being assessed and risk factors for graft and patient survival are unknown.

Materials And Methods: This is a retrospective study from 1989 to 2014 of CHLT in the United Network for Organ Sharing database. Endpoints were graft and patient survival at 1, 3, and 5 years, and risk factors were assessed using multivariable Cox proportional hazard models.

Results: The cohort included 186 patients. Both graft and patient survival at 1, 3, and 5 years were 85%, 77%, and 74%, respectively. Diabetes (hazard ratio [95% CI]: 2.28 [1.05, 4.92]; P = .036) was significantly associated with risk for graft failure and patient mortality in multivariable analysis. The post-2006 transplant era was associated with significantly improved graft survival and overall survival (hazard ratio [95% CI]: 0.45 [0.24, 0.87]; P = .017).

Conclusions: Acceptable outcomes are achievable in CHLT through careful candidate selection. As we continue to perform more CHLTs, outcomes and selection criteria need to be continually assessed.