COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasqualeAnesthetic considerations for combined heart--liver transplantation in patients with Fontan-associated liver diseaseHofer, Ryan E.; Christensen, Jon M.; Findlay, James Y.Author Information Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA Correspondence to Ryan E. Hofer, MD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Tel: +1 507 255 4234; e-mail: [email protected] Current Opinion in Organ Transplantation: October 2020 - Volume 25 - Issue 5 - p 501-505 doi: 10.1097/MOT.0000000000000800 Buy Metrics Abstract Purpose of review The success of the Fontan procedure has led to increased survival of patients born with certain congenital heart disease to the point that new sequlae, as a result of Fontan circulation, are being discovered. Included among these is Fontan-associated liver disease (FALD). The purpose of this review is to present available literature on the perioperative management of the combined heart--liver transplantation (CHLT) in patients with FALD. Recent findings The perioperative management of a combined heart-liver transplant in a patient with Fontan circulation is complex. The patient is at risk for hemodynamic disturbances, significant blood loss, coagulopathies, and metabolic derangements. The maintenance of an appropriate transpulmonary pressure gradient is paramount to success. Postoperative management should be accomplished by a multidisciplinary care team. Limited series have demonstrated good outcomes in patients who have undergone CHLT. Summary The perioperative management of CHLT in patients with FALD is complex and available literature is limited. Future studies are needed to further assess proper perioperative management of patients with FALD who undergo CHLT. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.