{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:43:27Z","timestamp":1753879407940,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"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 Transplantation"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Intraoperative gross liver inspection at the time of transplant can be used in determination of which failing Fontan patients should undergo heart\u2010only transplantation (HT) versus combined heart\u2013liver transplantation (CHLT). We describe the outcomes of Fontan patients listed for CHLT who underwent HT based on the gross pathology of the liver at time of transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>Six Fontan patients, ages 15 (IQR12,16) years, listed for CHLT received HT because of reassuring gross findings of the liver at the time of transplant. All patients survived to hospital discharge, after median hospital length of stay of 59 (IQR 42\u201377) days. Vasoplegia, prolonged need for milrinone because of diastolic dysfunction, acute kidney injury, and infection were common complications. Five patients had acute cellular rejection within 35\u2009days of heart transplant. At a median of 17 (IQR 10, 19) months from HT, all continue to have abnormal findings by abdominal imaging, with development of new hepatic nodules in three patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>Intraoperative gross liver inspection at the time of transplant can enable successful HT in Fontan patients with liver disease. However, a prolonged recovery period should be anticipated, with serial post\u2010HT liver assessments and vigilant monitoring for rejection. The long\u2010term liver prognosis remains uncertain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.70036","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:39:34Z","timestamp":1737977974000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decisions Using Intra\u2010Operative Gross Assessment of Fontan\u2010Associated Liver Disease: Implications for Heart\u2010Only Transplantation"],"prefix":"10.1111","volume":"29","author":[{"given":"Diana Milagros","family":"Torpoco Rivera","sequence":"first","affiliation":[{"name":"Division of Cardiology, the Children's Hospital of Michigan, Department of Pediatrics Central Michigan University College of Medicine  Detroit Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke\u2010You","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4494-1729","authenticated-orcid":false,"given":"Noelle","family":"Ebel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Bensen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos O.","family":"Esquivel","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manchula","family":"Navaratnam","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Division of Pediatric Cardiology at Lucile Packard Children's Hospital at Stanford University  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0818-3150","authenticated-orcid":false,"given":"Seth A.","family":"Hollander","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-2759","authenticated-orcid":false,"given":"David N.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.748566"},{"key":"e_1_2_7_3_1","unstructured":"OPTN \u201cMultiple Organ Transplants in the U.S. by Recipient Age \u201d2022. U.S. Multiple Organ Transplants Performed January 1 1991\u2013December 31 2022. Liver\u2010Heart 2022 https:\/\/optn.transplant.hrsa.gov\/data\/view\u2010data\u2010reports\/national\u2010data\/#."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.12.008"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.11.023"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2018.03.006"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14120"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.045597"},{"issue":"3","key":"e_1_2_7_9_1","article-title":"Identifying Predictors of Pediatric Heart Only Versus Combined Heart\u2010Liver Transplantation [Abstract]","volume":"22","author":"Zhang K.","year":"2022","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOT.0000000000001041"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.11.121"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.06.008"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2020.09.044"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2015.40"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2005.03.019"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.1"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.548016"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13102960"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.03.422"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.03.421"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31817fc2b8"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890\u2010198802000\u201000046"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.003754"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:48:47Z","timestamp":1737982127000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,27]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1111\/petr.70036"],"URL":"https:\/\/doi.org\/10.1111\/petr.70036","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"type":"print","value":"1397-3142"},{"type":"electronic","value":"1399-3046"}],"subject":[],"published":{"date-parts":[[2025,1,27]]},"assertion":[{"value":"2024-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70036"}}