Liver Allograft Provides Immunoprotection for the Cardiac Allograft in Combined Heart–Liver Transplantation

T. W. Wong, M. J. Gandhi, R. C. Daly, S. S. Kushwaha, N. L. Pereira, C. B. Rosen, M. D. Stegall, J. K. Heimbach, T. Taner

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


When transplanted simultaneously, the liver allograft has been thought to have an immunoprotective role on other organs; however, detailed analyses in simultaneous heart–liver transplantation (SHLT) have not been done to date. We analyzed patient outcomes and incidence of immune-mediated injury in 22 consecutive SHLT versus 223 isolated heart transplantation (IHT) recipients between January 2004 and December 2013, by reviewing 3912 protocol- and indication-specific cardiac allograft biopsy specimens. Overall survival was similar (86.4%, 86.4%, and 69.1% for SHLT and 93.3%, 84.7%, and 70.0% for IHT at 1, 5, and 10 years; p = 0.83). Despite similar immunosuppression, the incidence of T cell–mediated rejection (TCMR) was lower in SHLT (31.8%) than in IHT (84.8%) (p < 0.0001). Although more SHLT patients had preexisting donor-specific HLA antibody (22.7% versus 8.1%; p = 0.04), the incidence of antibody-mediated rejection was not different in SHLT compared with IHT (4.5% versus 14.8%, p = 0.33). While the left ventricular ejection fraction was comparable in both groups at 5 years, the incidence and severity of cardiac allograft vasculopathy were reduced in the SHLT recipients (42.9% versus 66.8%, p = 0.03). Simultaneously transplanted liver allograft was associated with reduced risk of TCMR (odds ratio [OR] 0.003, 95% confidence interval [CI] 0–0.02; p < 0.0001), antibody-mediated rejection (OR 0.04, 95% CI 0–0.46; p = 0.004), and cardiac allograft vasculopathy (OR 0.26, 95% CI 0.07–0.84; p = 0.02), after adjusting for other risk factors. These data suggest that the incidence of alloimmune injury in the heart allograft is reduced in SHLT recipients.

Original languageEnglish (US)
Pages (from-to)3522-3531
Number of pages10
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 1 2016


  • clinical research/practice
  • graft survival
  • heart (allograft) function/dysfunction
  • heart transplantation/cardiology
  • immunobiology
  • liver allograft function/dysfunction
  • liver transplantation/hepatology
  • rejection
  • rejection: T cell mediated (TCMR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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