Current State of Multiorgan Transplantation and Implications for Future Practice and Policy

Westphal, Scott G.; Langewisch, Eric; Miles, Clifford D.

doi:10.1053/j.ackd.2021.09.012

Cited by 7 publications

(8 citation statements)

References 83 publications

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“…Multi-organ transplantation is a lifesaving surgical procedure for patients with multiple organ failure and is a therapeutic option for select patients who may otherwise not survive [25,26]. Based on the obtained results and discussion, despite its major technical and logistical challenges, we have formulated the hypothesis that this procedure delivers acceptable mortality and rejection rates.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables

Sampaio,

Faleiro,

Vieira

et al. 2024

Transpl Int

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Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient’s mean age was 51.1 years (95% CI 48.52–53.67) and 84% (95% CI 80–87) were male. 71% (95% CI 59–83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41–53)] and cardiorenal syndrome [22% (95% CI 9–35)]. Also, 33% (95% CI 20–46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64–89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88–100) at 30 days, 81% (95% CI 76–86) at 1 year, 79% (95% CI 71–87) at 3, and 71% (95% CI 59–83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.

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Section: Discussionmentioning

confidence: 99%

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables

Sampaio,

Faleiro,

Vieira

et al. 2024

Transpl Int

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“…To this end, several proposed solutions that have been repeatedly suggested by the kidney transplant community deserve further consideration but require improved data reporting for adequate study. 6,7,9,10 These data can inform future OPTN proposals to define priorities for kidney multiorgan allocation.…”

Section: Data Needs For Potential Solutionsmentioning

confidence: 98%

“…Such data can inform proposals to prioritize these special groups above multiorgan recipients in the allocation sequence for all or a subset of kidneys. 6,9 Formal criteria for eligibility for thoracic–kidney transplants should replace subjectivity in listing, especially as safety-net kidney waitlisting for heart and lung recipients has been proposed. Determining appropriate criteria will require OPTN reporting of dialysis-dependent AKI, GFR trajectory, kidney failure, and death after non-kidney transplantation in recipients with varying degrees of pretransplant kidney dysfunction, perhaps through integration with the United States Renal Data System and large observational data consortia.…”

Section: Data Needs For Potential Solutionsmentioning

confidence: 99%

Right-Sizing Multiorgan Allocation Involving Kidneys

Husain

Hippen

Singh

et al. 2023

CJASN

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“…An alternative approach to the safety net, which prioritizes post-liver transplant patients above most local kidney-alone transplant candidates with longer waiting time, would be to promote living kidney donation which should be discussed with the patients prior to liver transplantation. 9 In the case that organs from a single donor could be allocated to several multi-organ candidates with different combinations, the local OPO decides which multi-organ patient receives prioritization, which has the potential to impact equity. 12 Another example where decision is left to the OPO's discretion, and thus potentially interfering with equity, is multivisceral transplants.…”

Section: Multi-organ Allocation Policy In the Eurotransplant Zone And...mentioning

confidence: 99%

Combined Organ Transplantation in Patients with Advanced Liver Disease

Zhang,

Lurje,

Lurje

et al. 2024

Semin Liver Dis

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Transplantation of the liver in combination with other organs is an increasingly performed procedure. Over the years, continuous improvement in survival could be realized through careful patient selection and refined organ preservation techniques, in spite of the challenges posed by aging recipients and donors, as well as the increased use of steatotic liver grafts. Herein, we revisit the epidemiology, allocation policies in different transplant zones, indications, and outcomes with regard to simultaneous organ transplants involving the liver, that is combined heart–liver, liver–lung, liver–kidney, and multivisceral transplantation. We address challenges surrounding combined organ transplantation such as equity, utility, and logistics of dual organ implantation, but also advantages that come along with combined transplantation, thereby focusing on molecular mechanisms underlying immunoprotection provided by the liver to the other allografts. In addition, the current standing and knowledge of machine perfusion in combined organ transplantation, mostly based on center experience, will be reviewed. Notwithstanding all the technical advances, shortage of organs, and the lack of universal eligibility criteria for certain multi-organ combinations are hurdles that need to be tackled in the future.

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Current State of Multiorgan Transplantation and Implications for Future Practice and Policy

Cited by 7 publications

References 83 publications

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables

Right-Sizing Multiorgan Allocation Involving Kidneys

Combined Organ Transplantation in Patients with Advanced Liver Disease

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