Outcomes and complications of combined heart-liver transplantation in patients with failing Fontan physiology: A systematic review
Bibliographic record
Abstract
BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure, which can lead to Fontan-associated liver disease (FALD) and multi-organ failure. Combined heart-liver transplantation (CHLT) is a potential lifesaving option for these patients. AIM To investigate the outcomes and complications of CHLT in patients with failing Fontan physiology. METHODS Seven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessed with the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals. RESULTS The pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%, respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Mean ischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renal replacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopic heart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30, P = 0.009) and ischemic time (MD: –65.93 minutes), with no major differences in perioperative morbidity. CONCLUSION CHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Future prospective studies are warranted to refine eligibility and improve long-term survival.
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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 | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.011 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".