title: Heart-lung-liver transplantation.
abstract: We report three patients with cystic fibrosis and one patient with primary biliary cirrhosis and plexogenic pulmonary hypertension who have undergone heart-lung-liver transplantation as a combined procedure. Liver transplantation was necessary in the three patients with cystic fibrosis because of portal hypertension secondary to either hepatic fibrosis or established cirrhosis in addition to their advanced lung disease. Three of the four patients were alive at 20, 50, and 100 months after transplantation (one patient with cystic fibrosis died on day 16 of pneumonia) with well-preserved pulmonary function (forced expiratory volume in 1 second 110%, 49%, and 100% predicted, respectively), normal hepatic function and New York Heart Association class 1 performance status. Heart-lung and concurrent liver transplantation is a feasible and successful procedure with a satisfactory long-term outcome in selected patients with advanced pulmonary and hepatic disease.
authors.affiliation: Transplant Unit Papworth Hospital, Cambridge, United Kingdom.
authors.forename: C M
authors.initials: CM
authors.lastname: Dennis
authors.forename: K D
authors.initials: KD
authors.lastname: McNeil
authors.forename: J
authors.initials: J
authors.lastname: Dunning
authors.forename: S
authors.initials: S
authors.lastname: Stewart
authors.forename: P J
authors.initials: PJ
authors.lastname: Friend
authors.forename: G
authors.initials: G
authors.lastname: Alexander
authors.forename: T W
authors.initials: TW
authors.lastname: Higenbottam
authors.forename: R Y
authors.initials: RY
authors.lastname: Calne
authors.forename: J
authors.initials: J
authors.lastname: Wallwork
mesh_terms: D000328:Adult; D001991:Bronchitis / Q000382:microbiology; D002423:Cause of Death; D003550:Cystic Fibrosis / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D006976:Hypertension, Pulmonary / Q000601:surgery; D008103:Liver Cirrhosis / Q000601:surgery; D008105:Liver Cirrhosis, Biliary / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D018579:Patient Selection; D018410:Pneumonia, Bacterial / Q000209:etiology; D011552:Pseudomonas Infections; D011550:Pseudomonas aeruginosa; D015996:Survival Rate; D016896:Treatment Outcome