Outcomes and complications of combined heart-liver transplantation in patients with failing Fontan physiology: A systematic review

Table 6 Postoperative complications and study conclusions

Ref.	MCS (n/N)	RRT (n/N)	Tracheostomy (n/N)	Rejection (n/N)	Infection (n/N)	Reoperation (n/N)	Conclusions
Vaikunth et al[19] (2019)	9/40	17/40	8/40	0	N/A	N/A	Further study needed to reduce early mortality and complications (MCS, RRT, bleeding, vasoplegia) in CHLT patients with failing Fontan physiology
Vaikunth et al[20] (2024)	2/9	3/9	0	7/9	N/A	N/A	CHLT is a viable option in Fontan patients with liver cirrhosis
Wu et al[18] (2024)	4/11	5/11	N/A	3/11	1/11	5/11	CHLT in Fontan patients is associated with higher morbidity; early intervention may improve outcomes
Sganga et al[21] (2021)	0	1/9	0	0	5/9	3/9	Despite higher liver disease burden, Fontan patients had comparable outcomes to HT
D’Souza et al[10] (2016)	N/A	2/7	N/A	0	N/A	N/A	CHLT is acceptable in failing Fontan + fibrosis; long-term data needed
Reardon et al[22] (2018)	N/A	N/A	N/A	2/5	N/A	0/5	CHLT is reasonable despite peri/postoperative risks
Lewis et al[34] (2023)	N/A	N/A	N/A	N/A	N/A	N/A	Fontan patients had worse outcomes with higher FALD scores; survival possibly better at experienced centers
Aggregate (%)	22%	36.84%	13.79%	12.34%	30%	32%	—

CHLT: Combined heart-liver transplantation; FALD: Fontan-associated liver disease; MCS: Mechanical circulatory support; RRT: Renal replacement therapy; N/A: Not applicable.