Innovations in combined cardiac-liver transplantation: robotic-assisted surgery and advanced organ preservation techniques

Abstract Background Combined cardiac and liver diseases pose a significant clinical challenge due to the complex interplay between these two organ systems. End-stage liver disease patients are at an increased risk for coronary artery disease, with a prevalence of approximately 30%, compared to 6% in the general population. This is driven by shared risk factors such as diabetes, hypertension, hyperlipidemia, and chronic inflammation. Managing dual-organ dysfunction is challenging, as liver disease exacerbates heart failure, while impaired cardiac function worsens liver perfusion, creating a cycle of organ deterioration. Main body of the abstract The pathophysiology of coronary artery disease in End-stage liver disease patients is characterized by cirrhotic cardiomyopathy, systemic vasodilation, and increased cardiac output, complicating both diagnosis and treatment. Recent advancements in surgical techniques, including robotic-assisted and minimally invasive procedures, have improved outcomes for patients with dual-organ failure. Robotic-assisted liver transplantation, first performed in 2023, has demonstrated reduced trauma and faster recovery times. Additionally, innovations in organ preservation, such as ex vivo normothermic perfusion, offer the potential for improved graft function, particularly in high-risk patients. Ethical dilemmas arise in organ allocation, as combined transplants necessitate careful balancing of resource use and patient benefit. Short conclusion The increasing demand for combined cardiac-liver transplantation highlights the need for continued research into robotic-assisted techniques, organ preservation technologies, and patient selection criteria. These advancements have the potential to improve long-term outcomes for this high-risk population, but further clinical trials and ethical discussions are crucial to refining these procedures.