{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T04:51:44Z","timestamp":1768884704679,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T00:00:00Z","timestamp":1468281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Combined heart and liver transplantation (<jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (<jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>) involving single ventricle physiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to describe the perioperative management of pediatric patients undergoing <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> at a single institution and to identify management strategies that may be used to optimize perioperative care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We did a retrospective database review of all patients receiving <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content> at a children's hospital between 2006 and 2014. Information collected included preoperative characteristics, intraoperative management, blood transfusions, and postoperative morbidity and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five pediatric <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>s were performed over an 8\u2010year period. All patients had a history of complex <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> with multiple sternotomies, three of whom had failing Fontan physiology. Patient age ranged from 7 to 23 years and weight from 29.5 to 68.5 kg. All <jats:styled-content style=\"fixed-case\">CHLT<\/jats:styled-content>s were performed using an en\u2010bloc technique where both the donor heart and liver were implanted together on cardiopulmonary bypass (<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content>). The median operating room time was 14.25 h, median <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> time was 3.58 h, and median donor ischemia time was 4.13 h. Patients separated from <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> on dopamine, epinephrine, and milrinone infusions and two required inhaled nitric oxide. All patients received a massive intraoperative blood transfusion post <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> with amounts ranging from one to three times the patient's estimated blood volume. The patient who required the most transfusions was in decompensated heart and liver failure preoperatively. Four of the five patients received an antifibrinolytic agent as well as a procoagulant (prothrombin complex concentrate or recombinant activated Factor <jats:styled-content style=\"fixed-case\">VII<\/jats:styled-content>) to assist with hemostasis. There were no 30\u2010day thromboembolic events detected. Postoperatively the median length of mechanical ventilation, <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> stay and stay to hospital discharge was 4, 8, and 37 days, respectively. All patients are alive and free from allograft rejection at this time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combined heart and liver transplantation in the pediatric population involves a complex group of patients with unique perioperative challenges. Successful management starts with thorough preoperative planning and communication and involves strategies to deal with massive intraoperative hemorrhage and coagulopathy in addition to protecting and supporting the transplanted heart and liver and meticulous surgical technique. An integrated multidisciplinary team approach is the cornerstone for successful outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12950","type":"journal-article","created":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T09:58:16Z","timestamp":1468317496000},"page":"976-986","source":"Crossref","is-referenced-by-count":22,"title":["Perioperative management of pediatric en\u2010bloc combined heart\u2013liver transplants: a case series review"],"prefix":"10.1111","volume":"26","author":[{"given":"Manchula","family":"Navaratnam","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glyn D.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhide","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julianne M.","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldo","family":"Concepcion","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seth A.","family":"Hollander","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandra","family":"Ramamoorthy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital Stanford University Medical Center Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,7,12]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Available at:https:\/\/optn.transplant.hrsa.gov\/data\/view-data-reports\/national-data\/#; 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