CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2024 19_11-12_424-510.15836/ccar2024.424Extended AbstractHeart failureSimultaneous heart-liver and heart-kidney transplantation: a case series from the University Hospital Centre Zagrebhttps://orcid.org/0000-0001-6276-4450KovačAntun Zvonimir*https://orcid.org/0000-0003-0561-6704PlanincIvohttps://orcid.org/0000-0001-5979-2346SkorićBoškohttps://orcid.org/0000-0001-7304-1127JakušNinahttps://orcid.org/0000-0003-2633-3439FabijanovićDorahttps://orcid.org/0000-0001-6270-2305MrzljakAnnahttps://orcid.org/0000-0002-0221-2758Bašić-JukićNikolinahttps://orcid.org/0000-0002-2492-3702GašparovićHrvojeLekićAntehttps://orcid.org/0000-0003-0507-4714ČolakŽeljkohttps://orcid.org/0000-0001-7884-8923SilovskiHrvojehttps://orcid.org/0000-0002-9642-3774PetrovićIgorhttps://orcid.org/0009-0002-3906-3300DebanOgnjanhttps://orcid.org/0000-0002-9262-3234KaštelanŽeljkohttps://orcid.org/0000-0002-4772-5549ČikešMajahttps://orcid.org/0000-0001-9101-1570MiličićDavorUniversity Hospital Centre Zagreb, Zagreb, CroatiaADDRESS FOR CORRESPONDENCE: Antun Zvonimir Kovač, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-99-2924-808 / E-mail: azkovac@gmail.com1120241120241911-124244251310202431102024Croatian Cardiac Society2024Croatian Cardiac SocietyKEYWORDS: heart-liver transplantationheart-kidney transplantationischemic heart diseasehereditary amyloidosispolycystic kidney disease
Introduction: Dual organ transplantation, such as heart-liver or heart-kidney, is a rare but essential option for patients with multi-organ failure. While outcomes for single-organ transplants are well-documented, reports of dual transplants are limited. (1-3) This case series presents two heart-liver and one heart-kidney transplant cases to provide insights into clinical outcomes and management. Aim: To analyze the clinical characteristics, clinical course, perioperative management, and post-transplant outcomes of patients undergoing simultaneous heart-liver and heart-kidney transplantation at the University Hospital Centre (UHC) Zagreb, Croatia.
Case series: Three patients underwent dual organ transplantation between January 2023 and September 2024. Two patients received heart-liver transplants for heart failure due to hereditary transthyretin amyloidosis, while one patient underwent heart-kidney transplantation for end-stage heart failure secondary to ischemic heart disease and renal failure associated with polycystic kidney disease. Surgical techniques and postoperative care were tailored to each patient’s clinical profile. The first patient, a 49-year-old male who underwent heart-liver transplantation, has a 20-month follow-up. His course included early liver graft rejection, successfully treated with pulse corticosteroids. Heart function remains preserved, and he initially had transient, low-intensity donor-specific antibodies (DSAs). The second patient, a 52-year-old male with heart-liver transplantation, has a one -month follow-up with preserved organ function, no rejection, and no DSAs. The third patient, a 54-year-old male who underwent heart-kidney transplantation, has a one-month follow-up complicated by prolonged postoperative peritoneal drainage, but both grafts are functioning well, with no rejection or DSAs (Table 1).
Patient characteristics in dual-organ transplantation.
Patient characteristics
CASE 1
CASE 2
CASE 3
Age, sex
49, male
52, male
54, male
Follow up
20 months
1 month
1 month
Transplanted organs
Heart and liver
Heart and liver
Heart and kidney
Etiology of primary organ failure
Hereditary TTR amyloidosis
Hereditary TTR amyloidosis
Ischemic heart diseasePolycystic kidney disease
Pretransplant laboratory values
ErythrocytesHemoglobin
4.38 x 1012/L142 g/L
4.02 x 1012/L128 g/L
3.83 x 1012/L109 g/L
Leukocytes
4.2 x 109/L
6.1 x 109/L
7.6 x 109/L
Platelets
170 x 109/L
196 x 109/L
129 x 109/L
Total bilirubinPV-INRASTALTGGTALP
27 µmol/L1.5543 U/L18 U/L97 U/L148 U/L
15 µmol/L1.0646 U/L93 U/L33 U/L73 U/L
28 µmol/L1.0468 U/L21 U/L14 U/L48 U/L
BUNCreatinineeGFR
10.5 mmol/L114 µmol/L66 mL/min/1,73 m2
8.5 mmol/L113 µmol/L64 mL/min/1,73 m2
16.9 mmol/L243 µmol/L25 mL/min/1,73 m2
NT-proBNPTroponin I
6759 ng/L172.7 ng/L
5407 ng/L105.5 ng/L
4101 ng/L37.0 ng/L
Posttransplant events
Surgical
Pericardial effusion
Pericardial effusion
Prolonged peritoneal drainagePericardial effusion
Infective
None
None
None
Neoplastic
None
None
None
Organ rejection
Early cellular liver graft rejection
None
None
Graft organ function
Both preserved
Both preserved
Both preserved
Donor-specific antibodies
Transient low intensity
None
None
Conclusion: Dual organ transplantation is a viable option in selected patients with favorable outcomes when managed appropriately. This case series from the UHC Zagreb highlights the importance of individualized care and follow-up to optimize survival and graft function. Further studies are needed to standardize protocols for these complex procedures.
LITERATUREItagakiSToyodaNMossNManciniDEgorovaNMikamiTOutcomes of Simultaneous Heart and Kidney Transplantation.J Am Coll Cardiol. 2023 February 28;81(8):729–40. 10.1016/j.jacc.2022.11.05336813371GuendouzSGrimbertPRaduCCherquiDSalloumCMongardonNHeart Transplantation, Either Alone or Combined With Liver and Kidney, a Viable Treatment Option for Selected Patients With Severe Cardiac Amyloidosis.Transplant Direct. 2022 June 17;8(7):e1323. 10.1097/TXD.000000000000132335747521HuangXSalernoDKovacDScheffertJHedvatJCarverBContemporary Immunosuppression Management and 1-Year Outcomes in Dual Organ Heart Transplantation.Clin Transplant. 2024 August;38(8):e15420. 10.1111/ctr.1542039113661