Introduction: Dual organ transplantation, such as heart-liver or heart-kidney, is a rare but essential option for patients with multi-organ failure. While outcomes for single-organ transplants are well-documented, reports of dual transplants are limited. (1-3) This case series presents two heart-liver and one heart-kidney transplant cases to provide insights into clinical outcomes and management. Aim: To analyze the clinical characteristics, clinical course, perioperative management, and post-transplant outcomes of patients undergoing simultaneous heart-liver and heart-kidney transplantation at the University Hospital Centre (UHC) Zagreb, Croatia.
Case series: Three patients underwent dual organ transplantation between January 2023 and September 2024. Two patients received heart-liver transplants for heart failure due to hereditary transthyretin amyloidosis, while one patient underwent heart-kidney transplantation for end-stage heart failure secondary to ischemic heart disease and renal failure associated with polycystic kidney disease. Surgical techniques and postoperative care were tailored to each patient’s clinical profile. The first patient, a 49-year-old male who underwent heart-liver transplantation, has a 20-month follow-up. His course included early liver graft rejection, successfully treated with pulse corticosteroids. Heart function remains preserved, and he initially had transient, low-intensity donor-specific antibodies (DSAs). The second patient, a 52-year-old male with heart-liver transplantation, has a one -month follow-up with preserved organ function, no rejection, and no DSAs. The third patient, a 54-year-old male who underwent heart-kidney transplantation, has a one-month follow-up complicated by prolonged postoperative peritoneal drainage, but both grafts are functioning well, with no rejection or DSAs (Table 1).
Conclusion: Dual organ transplantation is a viable option in selected patients with favorable outcomes when managed appropriately. This case series from the UHC Zagreb highlights the importance of individualized care and follow-up to optimize survival and graft function. Further studies are needed to standardize protocols for these complex procedures.