P33. Transitioning from a Planned Combined Heart-Liver Transplant to Isolated Heart Transplant has a Negative Impact on Survival

Objective
Combined heart-liver transplantation (CHLT) is a definitive therapy for patients with heart failure and advanced liver dysfunction. Despite advanced imaging techniques, histological data, and blood chemistries, tactile and visual assessment at the time of surgery may still impact the decision to whether to proceed with isolated heart transplant (HT) or CHLT. This study analyzes long-term impacts on survival and rejection for patients initially listed for CHLT who subsequently received an isolated HT.

Methods
The United Network for Organ Sharing (UNOS) database was queried to identify all patients who were initially waitlisted for both a heart and liver that underwent transplantation between 2000 and 2020. Patients were grouped into two categories 1) waitlisted for CHLT and underwent CHLT and 2) waitlisted for CHLT and underwent HT. Redo and triple-organ transplants were excluded from subsequent analysis. Chi-squared tests were used to analyze categorical variables, and log-rank tests were used to evaluate differences in survival.

Results
Between 2000 and 2020, 396 patients that were initially waitlisted for CHLT underwent transplantation. Out of the 396 patients, 345 underwent CHLT (87%) and 51 underwent isolated heart transplantation (13%) (Figure 1A). There was a significant survival benefit for the patients who underwent CHLT (p<0.001, Figure 1B); estimated survival at 1, 5, and 10 years was 88%, 81%, and 67% for CHLT and 72%, 61%, and 45% for isolated HT, respectively. The patients who underwent CHLT were significantly less likely than the patients who underwent isolated HT to experience acute rejection before hospital discharge (p<0.01) and within one year of transplant (p<0.001) (Figure 1C).

Conclusion
For patients initially listed for both organs, overall survival for patients undergoing CHLT was significantly better than isolated HT. Additionally, patients undergoing CHLT experienced significantly fewer episodes of rejection, providing further evidence of the liver's immunoprotective role in multiorgan transplantation. Surgeons should exercise caution when deciding whether to decline the liver for a patient initially listed for CHLT.

Danielle Mullis (1), Daniel Alnasir (1), Elbert E. Heng (1), Alyssa Garrison (1), Aravind Krishnan (1), Stefan Elde (1), Yuanjia Zhu (1), Jeffrey Teuteberg (1), Amy Gallo (1), Carlos Esquivel (1), C. Andrew Bonham (1), Y. Joseph Woo (1), John MacArthur (1), (1) Stanford University School of Medicine, Palo Alto, CA

Danielle Mullis

Poster Presenter

Danielle Mullis is a medical student at Stanford University. She completed her undergraduate studies at the University of Michigan, where she majored in Biological Sciences and Spanish. She worked for two years as an Emergency Medical Technician and MCAT teacher, while also doing inorganic chemistry research in the Szymczak Lab. She has been in the lab of Dr. Joseph Woo for the past two years, and is involved in the biological, clinical, and bioengineering sides of the lab. She is a Cardiovascular Interest Group Leader, CVI Early Career Committee member, and Cardinal Free Clinic volunteer. She is part of the Physician Scientist Training Program, where she dedicated an additional year to research in the Dr. Joseph Woo Lab during medical school. She has a strong interest in cardiac surgery and research.