{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:02:35Z","timestamp":1768435355617,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"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":["Pediatric Anesthesia"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>An increasing number of centers are undertaking combined heart and liver transplantation in adult and pediatric patients with congenital heart disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The primary aim of this study was to describe the perioperative management of a single center cohort, identifying challenges and potential solutions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective review of all patients undergoing combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022. Preoperative information included cardiac diagnosis, hemodynamics, and severity of liver disease. Intraoperative data included length of surgery, cardiopulmonary bypass time, and blood products transfused. Postoperative data included blood products transfused in the intensive care unit, time to extubation, length of intensive care unit stay, survival outcomes and 30\u2010day adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighteen patients underwent en bloc combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022, and the majority 15 (83%) were transplanted for failing Fontan circulation with Fontan Associated Liver Disease. Median surgical procedure time was 13.4 [11.5, 14.5]\u2009h with a cardiopulmonary bypass time of 4.3 [3.9, 5.8]\u2009h. Median total blood products transfused in the operating room post cardiopulmonary bypass was 89.4 [63.9, 127.0]\u2009mLs\/kg. Nine patients (50%) had vasoplegia during cardiopulmonary bypass. Activated prothrombin complex concentrates were used post cardiopulmonary bypass in 15 (83%) patients with a 30\u2010day thromboembolism rate of 22%. Median time to extubation was 4.0 [2.8, 6.5]\u2009days, median intensive care unit length of stay 20.0 [7.8, 48.3]\u2009days and median hospital length of stay 54.0 [30.5, 68.3]\u2009days. Incidence of renal replacement therapy was 11%; however, none required renal replacement therapy by the time of hospital discharge. Neurological events within 30\u2009days were 17% and the 30\u2009day and 1\u2009year survival was 89%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Perioperative challenges include major perioperative bleeding, unstable hemodynamics, and end organ injury including acute kidney injury and neurological events. Successful outcomes for en bloc combined heart and liver transplantation are possible with careful multidisciplinary planning, communication, patient selection, and integrated peri\u2010operative management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14977","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T14:09:59Z","timestamp":1723126199000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Perioperative Management of Pediatric Combined Heart and Liver Transplantation: A 17\u2009year single center experience"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-6640","authenticated-orcid":false,"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 California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma Xi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital, Stanford University Medical Center  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology Stanford Children's Hospital, Stanford University Medical Center  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tristan","family":"Margetson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Perfusion Stanford Hospital and Clinic, Stanford Children's Hospital  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Wolke","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford Children's Hospital, Stanford University Medical Center  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Stanford Children's Hospital, Stanford University Medical Center  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noelle H.","family":"Ebel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Hepatology and Nutrition Stanford Children's Hospital, Stanford University Medical Center  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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