American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant SurgeonsJournal Article
05 Jul 2025
Simultaneous heart liver transplantation (SHLT) has expanded in recent years, bolstered by increases in congenital heart disease (CHD) indications and improvements in organ preservation.
We performed a contemporary analysis of patients undergoing SHLT for CHD vs non-CHD, further exploring the impact of machine perfusion (MP).
Patients undergoing SHLT between 2010-2024 were retrospectively identified using the UNOS database, assessing a primary outcome of patient survival and secondary outcome of MP utilization. 535 patients underwent SHLT, 224(41. 9%) with CHD indication and 311(58. 1%) non-CHD.
CHD recipients had significantly lower one-(72. 9% vs. 89. 4%,p<0. 01) and five-year survival (66. 1% vs. 81. 4%,p<0. 01) compared to non-CHD recipients. CHD indication was independently associated with a two-fold increased mortality risk, compared to a non-CHD diagnosis (HR:2. 31, 95%CI:[1.
53,3. 47]). Decision tree boosting demonstrated a 2. 9% higher relative mortality likelihood after SHLT for recipients with CHD. From 2022-2024, SHLT MP utilization for CHD increased; among 111 patients, 18. 0% received a MP liver, 8. 1% a MP heart, and 10. 8% MP heart and MP liver.
In this analysis of modern SHLT cases, patients with CHD had suboptimal outcomes; several donor and recipient factors also impacted mortality. Awareness of these factors can guide pre-transplant optimization, donor/recipient matching, and strategic MP use to improve survival.
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