title: Combined lung and liver transplantation: analysis of a single-center experience.
abstract: Patients with end-stage lung disease complicated by cirrhosis are not expected to survive lung transplantation alone. Such patients are potential candidates for combined lung-liver transplantation (CLLT), however few reports document the indications and outcomes after CLLT. This is a review of a large single-center CLLT series. Eight consecutive CLLT performed during 2009-2012 were retrospectively reviewed. One patient received a third simultaneous heart transplant. Mean age was 42.5 ± 11.5 years. Pulmonary indications included cystic fibrosis (CF) (n = 3), idiopathic pulmonary fibrosis (n = 2), α1-antitrypsin deficiency (AATD) (n = 1) and pulmonary hypertension (n = 2). Liver indications were CF (n = 3), hepatitis C (n = 2), AATD (n = 1), cryptogenic (n = 1), and cardiac/congestive (n = 1). Urgency was reflected by median lung allocation score (LAS) of 41 (36.0-89.0) and median predicted FEV1 of 25.7%. Median donor age was 25 (20-58) years with median cold ischemia times of 147 minutes and 6.1 hours for lung and liver, respectively. Overall patient survival at 30 days, 90 days and 1 year was 87.5%, 75.0% and 71.4% respectively. One patient had evidence of acute lung rejection, and no patients had liver allograft rejection. Early postoperative mortalities (90 days) were caused by sepsis in 2 recipients who exhibited the highest LAS of 69.9 and 89.0. The remaining recipients had a median LAS of 39.5 and 100% survival at 1-year. Median length of stay was 25 days (7-181). Complications requiring operative intervention included bile duct ischemia (n = 1) and bile leak (n = 1), ischemia of the bronchial anastomosis (n = 1), and necrotizing pancreatitis with duodenal perforation (n = 1). This series reflects a large single-center CLLT experience. Sepsis is the most common cause of death. The procedure should be considered for candidates with LAS < 50.
authors.affiliation: Department of Surgery, Department of Medicine, Methodist Hospital, Houston, TX.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Yi
authors.forename: Sherilyn Gordon
authors.initials: SG
authors.lastname: Burroughs
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.forename: Scott
authors.initials: S
authors.lastname: Scheinin
authors.forename: Harish
authors.initials: H
authors.lastname: Seethamraju
authors.forename: Soma
authors.initials: S
authors.lastname: Jyothula
authors.forename: Howard
authors.initials: H
authors.lastname: Monsour
authors.forename: Robert
authors.initials: R
authors.lastname: McFadden
authors.forename: Hemangshu
authors.initials: H
authors.lastname: Podder
authors.forename: Ashish
authors.initials: A
authors.lastname: Saharia
authors.forename: Emad H
authors.initials: EH
authors.lastname: Asham
authors.forename: Maha
authors.initials: M
authors.lastname: Boktour
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
authors.forename: R Mark
authors.initials: RM
authors.lastname: Ghobrial
mesh_terms: D000328:Adult; D000367:Age Factors; D050377:Cold Ischemia; D003550:Cystic Fibrosis / Q000628:therapy; D058625:End Stage Liver Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D006084:Graft Rejection; D006333:Heart Failure; D016027:Heart Transplantation / Q000379:methods; D006526:Hepatitis C / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D054990:Idiopathic Pulmonary Fibrosis / Q000628:therapy; D007511:Ischemia; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000150:complications / Q000628:therapy*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult; D019896:alpha 1-Antitrypsin Deficiency / Q000628:therapy