Mortality Outcomes of Combined Heart and Liver Transplantation and Isolated Heart Transplantation Following Fontan Procedures: A Systematic Review and Meta‐Analysis
Bibliographic record
Abstract
BACKGROUND: Fontan-associated liver disease can progress to advanced fibrosis, raising the potential need for combined heart-liver 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-making. METHODS: 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-year mortality were included. Bias risks were assessed using the Newcastle-Ottawa Scale. We used random- and fixed-effect models, depending on heterogeneity, to estimate pooled effects. RESULTS: Sixteen studies were included in this analysis. CHLT was associated with a lower mortality rate per patient-year compared to HT (0.03 vs. 0.09; p < 0.01). However, after excluding studies in which transplantations were performed before the year 2000, the difference between groups was no longer statistically significant. One-year mortality rates were also not significantly different between CHLT and HT (0.09 vs. 0.14; p = 0.28), with similar results observed after excluding pre-2000 studies. CONCLUSION: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.037 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".