Dual-Organ Transplantation: Indications, Evaluation, and Outcomes for Heart-Kidney and Heart-Liver Transplantation: A Scientific Statement From the American Heart Association

Published 15 August 2023

Michelle M. Kittleson, MD, PhD, FAHA; Kavita Sharma, MD; Daniel C. Brennan, MD; Xingxing S. Cheng, MD; Sheryl L. Chow, PharmD, FAHA; Monica Colvin, MD, MS; Adam D. DeVore, MD, MHS, FAHA; Shannon M. Dunlay, MD, MS, FAHA; Meg Fraser, DNP, ANP-C; Jacqueline Garonzik-Wang, MD; Prateeti Khazanie, MD, MPH; Kevin M. Korenblat, MD; Duc T. Pham, MD

Circulation Aug 2023; 148(7)

• Advanced Heart Failure & Transplantation
• Endorsement
• Publications & Journals
• Standards & Guidelines

Over the past 5 decades, heart transplantation (HT) has become an important therapy for appropriate patients with advanced heart failure (HF), with a 1-year survival of almost 90% and a conditional half-life of 13 years. However, the presence of comorbidities, including concomitant renal or hepatic dysfunction, can pose a barrier to isolated HT. Because donor organ supply limits the availability of organ transplantation, appropriate allocation of this scarce resource is essential. Clear guidelines for simultaneous heart-kidney transplantation (SHKT) and simultaneous heart-liver transplantation (SHLT) are required.

The purposes of this scientific statement are (1) to describe the impact of pretransplantation renal and hepatic dysfunction on post-HT outcomes; (2) to discuss the assessment of pre-HT renal and hepatic dysfunction; (3) to provide an approach to patient selection for SHKT and SHLT and posttransplantation management; and (4) to explore the ethics of multiorgan transplantation (MOT) and the rationale of the safety net approach to dual-organ transplantation.

Read at Circulation