{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:22:31Z","timestamp":1792430551250,"version":"4.5.0"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T00:00:00Z","timestamp":1531872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>As the population of patients with a Fontan palliation grows so does, the number of patients with cardiac failure necessitating orthotopic heart transplant (<jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content>) and combined heart\u2013liver transplant (<jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>). There is recent evidence that current era cardiac transplant in Fontan patients has improved outcomes, but most studies have a preponderance of pediatrics patients in their cohorts. We examine our institutional experience with adult <jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> transplantation for failed Fontan physiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Retrospective analysis of patients at the Ahmanson\/<jats:styled-content style=\"fixed-case\">UCLA<\/jats:styled-content> Adult Congenital Heart Disease Center who underwent <jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> for failing Fontan physiology from January 1, 2002 to May 31, 2017. We identified 20 patients with single\u2010ventricle physiology and Fontan palliation who underwent <jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>. The median age was 29.5\u00a0years (range 19\u201044). Five patients underwent <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> because of biopsy proven hepatic cirrhosis. The median length of hospital stay was 23\u00a0days (range 8\u201076) post\u2010<jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> and 51 days (range 26\u201077) post\u2010<jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>. During a median follow\u2010up of 56\u00a0months (range 2\u2010178), there was one mortality occurring at 34\u00a0months post\u2010<jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> due to coronary vasculopathy. Most frequent early postoperative complications included bleeding and infection (55% and 20%, respectively) and surgical reintervention for bleeding complications (n\u00a0=\u00a08, 40%). One <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> patient experienced clinically significant hepatic rejection requiring admission and steroid treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite inherent risks and complexities of <jats:styled-content style=\"fixed-case\">OHT<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> in patients with a failed Fontan, transplant is a reasonable therapy. Peri\u2010 and postoperative complications are common and may require surgical reintervention. Continued observation of practices and unifying themes may help improve patient selection, pre\u2010 and postoperative treatment and ultimately outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.13329","type":"journal-article","created":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T03:58:19Z","timestamp":1530071899000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":67,"title":["Heart and heart\u2013liver transplantation in adults with failing Fontan physiology"],"prefix":"10.1111","volume":"32","author":[{"given":"Leigh C.","family":"Reardon","sequence":"first","affiliation":[{"name":"Ahmanson\/UCLA Adult Congenital Heart Disease Center  Los Angeles California"},{"name":"Division of Pediatric Cardiology UCLA Children's Heart Center  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene C.","family":"DePasquale","sequence":"additional","affiliation":[{"name":"Ahmanson\/UCLA Cardiomyopathy Center  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Tarabay","sequence":"additional","affiliation":[{"name":"Ahmanson\/UCLA Adult Congenital Heart Disease Center  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cruz","sequence":"additional","affiliation":[{"name":"Ahmanson\/UCLA Cardiomyopathy Center  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillel","family":"Laks","sequence":"additional","affiliation":[{"name":"UCLA Department of Surgery, Cardiothoracic Surgery  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reshma M.","family":"Biniwale","sequence":"additional","affiliation":[{"name":"UCLA Department of Surgery, Cardiothoracic Surgery  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald W.","family":"Busuttil","sequence":"additional","affiliation":[{"name":"UCLA Department of Surgery Pfleger Liver Institute  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fady M.","family":"Kaldas","sequence":"additional","affiliation":[{"name":"UCLA Department of Surgery Pfleger Liver Institute  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sammy","family":"Saab","sequence":"additional","affiliation":[{"name":"UCLA Department of Medicine Pfleger Liver Institute  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Venick","sequence":"additional","affiliation":[{"name":"UCLA Department of Pediatric Gastroenterology  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannette P.","family":"Lin","sequence":"additional","affiliation":[{"name":"Ahmanson\/UCLA Adult Congenital Heart Disease Center  Los Angeles 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