title: Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient?
abstract: Simultaneous thoracic and abdominal (STA) transplantation is controversial because two organs are allocated to a single individual. We studied wait-list urgency, and whether transplantation led to successful outcomes. Candidates and recipients for heart-kidney (SHK), heart-liver (SHLi), lung-liver (SLuLi) and lung-kidney (SLuK) were identified through the United Network for Organ Sharing (UNOS) and outcomes were compared to single-organ transplantation. Since 1987, there were 1801 STA candidates and 836 recipients. Wait-list survival at 1- and 3 years for SHK (67.4%, 40.8%; N = 1420), SHLi (65.7%, 43.6%; N = 218) and SLuLi (65.7%, 41.0%; N = 122), was lower than controls (p < 0.001), whereas for SLuK (65.0%, 51.6%; N = 41) it was comparable (p = 0.34). All STA groups demonstrated similar 1- and 5 years posttransplant survival to thoracic controls. Compared to abdominal controls, 1- and 5 years posttransplant survival in SHK (85.3%, 74.0%; N = 684), SLuLi (75.5%, 59.0%; N= 42) and SLuK (66.7%, 55.6%; N = 18) was decreased (p < 0.01), but SHLi (85.9%, 74.3%; N = 92) was comparable (p = 0.81). In summary, STA candidates had greater risk of wait-list mortality compared to single-organ candidates. STA outcomes were similar to thoracic transplantation; however, outcomes were similar to abdominal transplantation for SHLi only. Although select patients benefit from STA, risk-exposure variables for decreased survival should be identified, aiming to eliminate futile transplantation.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Wolf
authors.forename: M E
authors.initials: ME
authors.lastname: Sulewski
authors.forename: J R
authors.initials: JR
authors.lastname: Cassuto
authors.forename: M H
authors.initials: MH
authors.lastname: Levine
authors.forename: A
authors.initials: A
authors.lastname: Naji
authors.forename: K M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: A
authors.initials: A
authors.lastname: Shaked
authors.forename: P L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D005260:Female; D016041:Heart-Lung Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*