Combined Thoracic and Abdominal Organ Transplantation: Special Considerations

Abstract

Combined thoracic-abdominal organ transplants are infrequently performed procedures indicated for patients with failure of two or more transplantable organs. In this review, we discuss recipient selection, surgical considerations, anesthetic management, and outcomes associated with common combinations of thoracic-abdominal transplant operations. General principles regarding the postoperative care of these patients are also discussed. These procedures present a unique challenge requiring specialized knowledge, technical expertise, and leadership from the anesthesiology team throughout the perioperative period.

Normothermic Machine Perfusion Systems: Where Do We Go From Here?

“…Patients suffering from >1 end-stage organ disease 97 (eg, heart-lungs, 98 liver-lungs, 97,99 or liver-kidney 100 ) can undergo multiorgan transplantation. Clinical case reports have evaluated NMP's applicability during combined liverlung transplantation in prolonging preservation times of 1 implicated organ (ie, liver 77 and lungs [101][102][103] ).…”

“…The administration of therapies through the perfusate has several benefits that make NMP an attractive therapeutic option, including more efficient delivery, lower doses, and reduced unwanted side effects in nontarget organs. 174 The immunomodulatory properties of mesenchymal stem cells 57–159 and multipotent adult progenitor cells 160–162 have shown beneficial effects during liver, lung, and kidney NMP, presumably due to their immunomodulatory properties, which prompt both anti-inflammatory and regenerative responses. 157,160–162 In human models, initially discarded kidneys 160 and livers 161 treated with multipotent adult progenitor cells or preterm-neonate progenitor cells 162 exhibited improved viability, even meeting established criteria.…”

Thoracic Transplant Anesthesiology: Keeping Up With Advances and Developments of Allied Specialties

“…Yager and colleagues in this issue discuss preoperative considerations, ethical dilemmas, and intraoperative management and postoperative care of patients undergoing combined heart-kidney, heart-liver and lung-liver transplants. 28 The authors did an excellent job of reviewing the topic, which has recommendations mostly based on specialized centers' experiences. They recommend the involvement of anesthesiologists from the beginning of the selection process, a multidisciplinary, team-based approach, and postoperative care in a cardiothoracic surgical intensive care unit.…”