{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:09:13Z","timestamp":1791824953774,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T00:00:00Z","timestamp":1757203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fontan\u2010associated liver disease can progress to advanced fibrosis, raising the potential need for combined heart\u2013liver transplantation (CHLT) in selected patients. However, the benefits of CHLT over isolated orthotopic heart transplantation (HT), particularly in terms of mortality, remain uncertain. In this systematic review, we compared mortality outcomes following CHLT versus HT in patients with Fontan circulation, with the aim of supporting clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review was conducted according to the 2020 PRISMA guidelines and registered in PROSPERO. PubMed, Scopus, and Embase were searched. Studies examining HT or CHLT in patients with Fontan circulation that provided information about total and\/or 1\u2010year mortality were included. Bias risks were assessed using the Newcastle\u2010Ottawa Scale. We used random\u2010 and fixed\u2010effect models, depending on heterogeneity, to estimate pooled effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen studies were included in this analysis. CHLT was associated with a lower mortality rate per patient\u2010year compared to HT (0.03 vs. 0.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). However, after excluding studies in which transplantations were performed before the year 2000, the difference between groups was no longer statistically significant. One\u2010year mortality rates were also not significantly different between CHLT and HT (0.09 vs. 0.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28), with similar results observed after excluding pre\u20102000 studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall, this systematic review suggests that CHLT may result in mortality rates comparable to those of isolated HT. These findings support the consideration of CHLT in patients with concomitant liver disease and reinforce the importance of comprehensive liver evaluation in transplant candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70174","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:54:39Z","timestamp":1757314479000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mortality Outcomes of Combined Heart and Liver Transplantation and Isolated Heart Transplantation Following Fontan Procedures: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1938-312X","authenticated-orcid":false,"given":"Oscar","family":"Holmvard","sequence":"first","affiliation":[{"name":"D'Or Institute for Research and Education (IDOR)  Rio de Janeiro RJ 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Filgueiras","family":"Pacheco","sequence":"additional","affiliation":[{"name":"D'Or Institute for Research and Education (IDOR)  Rio de Janeiro RJ Brazil"},{"name":"Liver Transplant Surgery Department Rede D'Or  Rio de Janeiro RJ Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0031-5785","authenticated-orcid":false,"given":"Daniella Braz","family":"Parente","sequence":"additional","affiliation":[{"name":"D'Or Institute for Research and Education (IDOR)  Rio de Janeiro RJ Brazil"},{"name":"Radiology Department, Federal University of Rio de Janeiro (UFRJ)  Rio de Janeiro RJ Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-9905","authenticated-orcid":false,"given":"Ronir Raggio","family":"Luiz","sequence":"additional","affiliation":[{"name":"D'Or Institute for Research and Education (IDOR)  Rio de Janeiro RJ Brazil"},{"name":"Institute for Studies in Public Health\u2014IESC 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