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Progress in Combined Liver–lung Transplantation at a Single Center
Combined liver–lung transplantation is an uncommon, although vital, procedure for patients with simultaneous end-stage lung and liver disease. The utility of lung–liver transplant has been questioned because of initial poor survival outcomes, particularly when compared with liver-alone transplant re...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121433/ https://www.ncbi.nlm.nih.gov/pubmed/37096152 http://dx.doi.org/10.1097/TXD.0000000000001482 |
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author | Connor, Ashton A. Huang, Howard J. Mobley, Constance M. Graviss, Edward A. Nguyen, Duc T. Goodarzi, Ahmad Saharia, Ashish Yau, Simon Hobeika, Mark J. Suarez, Erik E. Moaddab, Mozhgon Brombosz, Elizabeth W. Moore, Linda W. Yi, Stephanie G. Gaber, A. Osama Ghobrial, Rafik Mark |
author_facet | Connor, Ashton A. Huang, Howard J. Mobley, Constance M. Graviss, Edward A. Nguyen, Duc T. Goodarzi, Ahmad Saharia, Ashish Yau, Simon Hobeika, Mark J. Suarez, Erik E. Moaddab, Mozhgon Brombosz, Elizabeth W. Moore, Linda W. Yi, Stephanie G. Gaber, A. Osama Ghobrial, Rafik Mark |
author_sort | Connor, Ashton A. |
collection | PubMed |
description | Combined liver–lung transplantation is an uncommon, although vital, procedure for patients with simultaneous end-stage lung and liver disease. The utility of lung–liver transplant has been questioned because of initial poor survival outcomes, particularly when compared with liver-alone transplant recipients. METHODS. A single-center, retrospective review of the medical records of 19 adult lung–liver transplant recipients was conducted, comparing early recipients (2009–2014) with a recent cohort (2015–2021). Patients were also compared with the center’s single lung or liver transplant recipients. RESULTS. Recent lung–liver recipients were older (P = 0.004), had a higher body mass index (P = 0.03), and were less likely to have ascites (P = 0.02), reflecting changes in the etiologies of lung and liver disease. Liver cold ischemia time was longer in the modern cohort (P = 0.004), and patients had a longer posttransplant length of hospitalization (P = 0.048). Overall survival was not statistically different between the 2 eras studied (P = 0.61), although 1-y survival was higher in the more recent group (90.9% versus 62.5%). Overall survival after lung–liver transplant was equivalent to lung-alone recipients and was significantly lower than liver-alone recipients (5-y survival: 52%, 51%, and 75%, respectively). Lung–liver recipient mortality was primarily driven by deaths within 6 mo of transplant due to infection and sepsis. Graft failure was not significantly different (liver: P = 0.06; lung: P = 0.74). CONCLUSIONS. The severity of illness in lung–liver recipients combined with the infrequency of the procedure supports its continued use. However, particular attention should be paid to patient selection, immunosuppression, and prophylaxis against infection to ensure proper utilization of scarce donor organs. |
format | Online Article Text |
id | pubmed-10121433 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-101214332023-04-23 Progress in Combined Liver–lung Transplantation at a Single Center Connor, Ashton A. Huang, Howard J. Mobley, Constance M. Graviss, Edward A. Nguyen, Duc T. Goodarzi, Ahmad Saharia, Ashish Yau, Simon Hobeika, Mark J. Suarez, Erik E. Moaddab, Mozhgon Brombosz, Elizabeth W. Moore, Linda W. Yi, Stephanie G. Gaber, A. Osama Ghobrial, Rafik Mark Transplant Direct Liver Transplantation Combined liver–lung transplantation is an uncommon, although vital, procedure for patients with simultaneous end-stage lung and liver disease. The utility of lung–liver transplant has been questioned because of initial poor survival outcomes, particularly when compared with liver-alone transplant recipients. METHODS. A single-center, retrospective review of the medical records of 19 adult lung–liver transplant recipients was conducted, comparing early recipients (2009–2014) with a recent cohort (2015–2021). Patients were also compared with the center’s single lung or liver transplant recipients. RESULTS. Recent lung–liver recipients were older (P = 0.004), had a higher body mass index (P = 0.03), and were less likely to have ascites (P = 0.02), reflecting changes in the etiologies of lung and liver disease. Liver cold ischemia time was longer in the modern cohort (P = 0.004), and patients had a longer posttransplant length of hospitalization (P = 0.048). Overall survival was not statistically different between the 2 eras studied (P = 0.61), although 1-y survival was higher in the more recent group (90.9% versus 62.5%). Overall survival after lung–liver transplant was equivalent to lung-alone recipients and was significantly lower than liver-alone recipients (5-y survival: 52%, 51%, and 75%, respectively). Lung–liver recipient mortality was primarily driven by deaths within 6 mo of transplant due to infection and sepsis. Graft failure was not significantly different (liver: P = 0.06; lung: P = 0.74). CONCLUSIONS. The severity of illness in lung–liver recipients combined with the infrequency of the procedure supports its continued use. However, particular attention should be paid to patient selection, immunosuppression, and prophylaxis against infection to ensure proper utilization of scarce donor organs. Lippincott Williams & Wilkins 2023-04-20 /pmc/articles/PMC10121433/ /pubmed/37096152 http://dx.doi.org/10.1097/TXD.0000000000001482 Text en Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Liver Transplantation Connor, Ashton A. Huang, Howard J. Mobley, Constance M. Graviss, Edward A. Nguyen, Duc T. Goodarzi, Ahmad Saharia, Ashish Yau, Simon Hobeika, Mark J. Suarez, Erik E. Moaddab, Mozhgon Brombosz, Elizabeth W. Moore, Linda W. Yi, Stephanie G. Gaber, A. Osama Ghobrial, Rafik Mark Progress in Combined Liver–lung Transplantation at a Single Center |
title | Progress in Combined Liver–lung Transplantation at a Single Center |
title_full | Progress in Combined Liver–lung Transplantation at a Single Center |
title_fullStr | Progress in Combined Liver–lung Transplantation at a Single Center |
title_full_unstemmed | Progress in Combined Liver–lung Transplantation at a Single Center |
title_short | Progress in Combined Liver–lung Transplantation at a Single Center |
title_sort | progress in combined liver–lung transplantation at a single center |
topic | Liver Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121433/ https://www.ncbi.nlm.nih.gov/pubmed/37096152 http://dx.doi.org/10.1097/TXD.0000000000001482 |
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