Indications for and outcomes after combined lung and liver transplantation: a single-center experience on 13 consecutive cases.
BACKGROUND
Combined lung and liver transplantation (Lu-LTx) is a therapeutic option for selected patients with coexisting lung and liver disease. For several reasons, Lu-LTx is performed in few centers and information about the technical issues, posttransplant management and long-term outcomes associated with this procedure is limited.


METHODS
We analyzed data from 13 consecutive patients who underwent combined Lu-LTx at Hannover Medical School (Hannover, Germany) between April 1999 and December 2003. The main indications were cystic fibrosis, alpha1-proteinase inhibitor deficiency and portopulmonary hypertension. All patients had advanced cirrhosis and severe pulmonary disease manifestation.


RESULTS
Ten patients received a sequential double Lu-LTx, one patient received a single Lu-LTx, one received a double lung and split liver transplantation, and one received an en-bloc heart-lung and liver transplantation. Immunosuppression was based on cyclosporine in a triple/quadruple regimen. Postoperative surgical complications occurred in eight patients. There were two perioperative deaths; two patients died during the first year on day 67 and 354, respectively, and one patient died at month 53. The overall patient survival rates at 1, 3, and 5 years were 69%, 62%, and 49%, respectively.


CONCLUSIONS
Combined Lu-LTx is a therapeutic option for highly selected patients with end-stage lung and liver disease with acceptable long-term outcome.
Grannas
Gerrit
G
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. grannas.gerrit@mh-hannover.de
Neipp
Michael
M
Hoeper
Marius M
MM
Gottlieb
Jens
J
Lück
Rainer
R
Becker
Thomas
T
Simon
Andre
A
Strassburg
Christian P
CP
Manns
Michael P
MP
Welte
Tobias
T
Haverich
Axel
A
Klempnauer
Jürgen
J
Nashan
Björn
B
Strueber
Martin
M
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery; D007239:Infections / Q000453:epidemiology; D008107:Liver Diseases / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis