Single-Center Long-Term Analysis of Combined Liver-Lung Transplant Outcomes

Abstract

BackgroundCombined lung-liver transplantation (LLT) applies 2 technically challenging transplants in 1 patient with severe 2-organ failure.MethodsInstitutional medical records and United Network for Organ Sharing database were queried for patients at our institution that underwent LLT from 2000 to 2016.ResultsTwelve LLTs were performed from 2000 to 2016 including 9 male and 3 female recipients with a median age of 28.36 years. Indications for lung transplantation were cystic fibrosis (8), idiopathic pulmonary fibrosis (3), and pulmonary fibrosis secondary to hepatopulmonary syndrome (1). Indications for liver transplantation were cystic fibrosis (8), alcoholic cirrhosis (1), idiopathic cirrhosis (2), and alpha-1 antitrypsin deficiency (1). Median forced expiratory volume in 1 second at transplant was 27.8% (±20.38%), and mean Model for End-Stage Liver Disease was 10.5 (±4.68). Median hospital stay was 44.5 days. Seventy-five percent of recipients had 1+ new infection during their transplant hospitalization. Patients experienced 0.68 incidences of acute rejection per year with a 41.7% (95% confidence interval, 21.3%-81.4%) probability of freedom from rejection in the first-year. Patient survival was 100% at 30 days, 91.6% at 1 year, and 71.3% at 3 years. At the time of analysis, 7 of 12 patients were alive, of whom 3 survived over 8 years post-LLT. Causes of death were primary liver graft failure (1), bronchiolitis obliterans syndrome (2), and solid tumor malignancies (2).ConclusionsOur results indicate that LLT is associated with comparable survival to other LLT series and provides a granular assessment of infectious and rejection rates in this rare population.

Immunosuppression considerations in simultaneous organ transplant

“…Although no robust studies are available to favor any particular induction or maintenance regimen in CLLT, rejection is common. Frieschlag et al 58 found that 75% of their CLLT patients had at least minimal acute cellular rejection (grade A1) in the lung within the first year. Grannas et al 56 observed that early acute rejection (within 1 year) occurred only in CLLT recipients who did not receive basiliximab induction therapy and were on azathioprine instead of mycophenolate ( n = 2/13).…”

Organ Transplantation for Cystic Fibrosis

“…For the few individuals who require combined lung-liver transplant, survival appears comparable to lung-only transplant recipients. 78 Pancreatic insufficiency is common, affecting >85% of adults with CF. A recent review reported that pancreaticsufficient patients had a higher risk of mortality compared with pancreatic-insufficient patients with CF that underwent lung transplantation.…”

Cystic Fibrosis–Associated Liver Disease in Lung Transplant Recipients

“…CF is the most common indication for SLLT. From 2005 to 2016, 52 SLLTs were performed in the United States, following the introduction of the lung allocation score (LAS) . The mean Model for End‐Stage Liver Disease (MELD) score was 10.5 (±4.68).…”

“…From 2005 to 2016, 52 SLLTs were performed in the United States, following the introduction of the lung allocation score (LAS). (50) The mean Model for End-Stage Liver Disease (MELD) score was 10.5 (±4.68). The 1-, 5-, and 10-year survival rates in this cohort were 82.7%, 69.0%, and 55.5%, respectively, and 30 (57.7%) of these transplants were performed in individuals with CF.…”