The following are key points to remember from an American Heart Association Scientific Statement on dual-organ transplantation: indications, evaluation, and outcomes for heart-kidney and heart-liver transplantation:

1. Heart transplantation is the preferred therapy for appropriate patients with advanced heart failure (HF), but the presence of concomitant renal or hepatic dysfunction can pose a barrier to isolated heart transplantation.
2. Because donor organ supply limits the availability of organ transplantation, appropriate allocation of this scarce resource is essential; thus, clear guidance for simultaneous heart-kidney transplantation (SHKT) and simultaneous heart-liver transplantation (SHLT) is urgently required.
3. Patients with established glomerular filtration rate (GFR) <30 mL/min/1.73 m² may be considered for SHKT.
4. Patients with established GFR of 30-44 mL/min/1.73 m² and firm evidence of chronic kidney disease such as small kidney size or persistent proteinuria >0.5 g/d in the presence of stable hemodynamics may qualify for SHKT on an individual basis.
5. Patients with established GFR of 45-59 mL/min/1.73 m² may not be appropriate for SHKT.
6. There are no current consensus criteria for SHLT. The evaluation of patients with advanced HF being considered for transplantation with concomitant liver disease focuses on whether the liver disease may reverse with optimization of cardiac function or is advanced enough to affect perioperative risk or require dual-organ transplantation.
7. The most common cardiac indication for SHLT is cardiac cirrhosis, often from congenital heart disease, particularly the failing Fontan with Fontan-associated liver disease (FALD).
8. Other cardiac indications for SHLT include metabolic disorders with cardiac complications that are curable with liver transplantation, including familial hypercholesterolemia and variant transthyretin amyloidosis, although the latter is less common with the advent of effective disease-modifying therapy.
9. In the setting of organ scarcity, SHKT and SHLT must balance the benefit to the individual with that of other candidates awaiting single-organ transplantation.
10. Finally, future efforts are indicated to standardize the assessment of renal and hepatic disease and the criteria for SHKT and SHLT and to assess outcomes of simultaneous versus delayed multi-organ transplantation to optimize the allocation of the scarce resource of donor organs.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Homozygous Familial Hypercholesterolemia, Acute Heart Failure, Heart Transplant, Interventions and Structural Heart Disease

Keywords: Amyloidosis, Familial, Cardiac Surgical Procedures, Donor Selection, Fontan Procedure, Glomerular Filtration Rate, Heart Defects, Congenital, Heart Failure, Heart Transplantation, Hemodynamics, Hypercholesterolemia, Kidney Diseases, Kidney Transplantation, Liver Cirrhosis, Liver Diseases, Liver Transplantation, Metabolic Diseases, Proteinuria, Renal Insufficiency, Chronic

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