title: Combined liver-thoracic transplantation: single-center experience with introduction of the 'Liver-first' principle.
abstract: Combined liver/thoracic transplantation (cLiThTx) is a complex procedure for end-stage/advanced liver and heart(H)/lung(Lu) disease. To avoid futile use of multiple organs in single recipients, results should be scrutinously analyzed. Single-center cLiThTx (04/2000-12/2015) were reviewed for the following: demographics, indications, surgical technique, complications, rejection, and five-year patient survival. Results are reported as median (range). Fourteen consecutive patients underwent cLiThTx: 3 cLiHTx, 10 cLiLuTx, and 1 cLiHLuTx. Recipient age was 42 years (17-63 years). Most frequent indications were cystic fibrosis (n = 5), hepatopulmonary fibrosis (n = 2), amyloidosis (n = 2), and epithelioid hemangio-endothelioma (n = 2). Thoracic organs were transplanted first, except in three where LiTx preceded LuTx. In the latter, lungs were preserved by normothermic ex vivo lung perfusion. Stenting was performed for stenosis of bile duct (n = 4), hepatic artery (n = 2), and bronchus (n = 2). Abdominal interventions were required for bleeding (n = 3), evisceration (n = 1), and adhesiolysis (n = 1). One liver (cLiLuTx) was lost to hepatic artery thrombosis 3 months post-transplant and successfully retransplanted. One patient (cLiHTx) died 4 months post-transplant (myocardial infarction). Follow-up was 4 years (2 months-16 years). One liver and 5 pulmonary rejections occurred, all mild and reversible. Two patients developed bronchiolitis obliterans, one is clinically well 16 years post-transplant, and the other successfully retransplanted. Estimated 5-year patient survival is 90%. CLiThTx is safe with excellent short-/long-term surgical and immunological results.
authors.affiliation: Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium.|Department of Clinical and Experimental Medicine, Thoracic Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Laurens J
authors.initials: LJ
authors.lastname: Ceulemans
authors.affiliation: Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Strypstein
authors.affiliation: Department of Cardiovascular Sciences, Anaesthesiology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Arne
authors.initials: A
authors.lastname: Neyrinck
authors.affiliation: Department of Clinical and Experimental Medicine, Pneumology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Verleden
authors.affiliation: Department of Clinical and Experimental Medicine, Pneumology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Ruttens
authors.affiliation: Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Diethard
authors.initials: D
authors.lastname: Monbaliu
authors.affiliation: Department of Clinical and Experimental Medicine, Thoracic Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: De Leyn
authors.affiliation: Department of Cardiovascular Sciences, Cardiology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vanhaecke
authors.affiliation: Department of Cardiovascular Sciences, Cardiac Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.affiliation: Department of Clinical and Experimental Medicine, Hepatology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.affiliation: Department of Clinical and Experimental Medicine, Pneumology, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Verleden
authors.affiliation: Department of Clinical and Experimental Medicine, Thoracic Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.affiliation: Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy; D007511:Ischemia; D008107:Liver Diseases / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: combined liver-thoracic transplantation; ex vivo lung perfusion; heart transplantation; liver transplantation; lung transplantation