Conquering combined thoracic organ and liver transplantation

Yi, Stephanie G.; Lunsford, Keri E.; Bruce, Courtenay R.; Ghobrial, Rafik M.

doi:10.1097/mot.0000000000000509

Cited by 18 publications

(12 citation statements)

References 48 publications

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“…Organ allocation for CLLT patients is generally driven by the lungs. 7 , 13 , 14 , 22 The MELD scores for HMH patients are similar to the MELD scores of US national CLLT recipients. 14 These allocation scores may not accurately reflect illness severity in multiorgan transplant candidates.…”

Section: Discussionmentioning

confidence: 52%

“…We attribute improvements in post-CLLT outcomes to increased center-specific experience 3 , 7 , 16 with patient selection, immunosuppression, and antimicrobial stewardship. In addition, changes in postoperative surveillance helped defer complications to later dates posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…Donor and patient operations for CLLT followed the surgical procedures described previously utilizing a lung-first approach. 3 , 7 …”

Section: Methodsmentioning

confidence: 99%

“…Donor and patient operations for CLLT followed the surgical procedures described previously utilizing a lungfirst approach. 3,7 To better understand how patient selection and outcomes have changed over time, the cohort was divided into 2 eras: 2009 to 2014 and 2015 to 2021. In 2015, the lung transplantation team at HMH introduced the Houston Methodist Lung Transplant Risk Model 16 to inform the decision on whether to list a patient for transplant.…”

Section: Methodsmentioning

confidence: 99%

“… 4 - 6 Most initial cases in the United States were pediatric, with adult cases growing in prevalence over time. 2 , 7 , 8 Many CF patients with severe liver dysfunction who received LuT would experience hepatic decompensation postoperatively, leading to increased mortality. 2 Patients with α-1 antitrypsin deficiency may also have concurrent lung and liver failure necessitating CLLT.…”

mentioning

confidence: 99%

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Progress in Combined Liver–lung Transplantation at a Single Center

Connor

Huang

Mobley

et al. 2023

Transplantation Direct

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Background. 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.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

“…Donor and patient operations for CLLT followed the surgical procedures described previously utilizing a lung-first approach. 3 , 7 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Progress in Combined Liver–lung Transplantation at a Single Center

Connor

Huang

Mobley

et al. 2023

Transplantation Direct

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Liver transplantation and cardiac illness: Current evidences and future directions

Jha

Lata

2020

J Hepato Biliary Pancreat

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Contraindications to liver transplantation are gradually narrowing. Cardiac illness and chronic liver disease may manifest independently or may be superimposed on each other due to shared pathophysiology. Cardiac surgery involving the cardiopulmonary bypass in patients with Child-Pugh Class C liver disease is associated with a high risk of perioperative morbidity and mortality. Liver transplantation involves hemodynamic perturbations, volume shifts, coagulation abnormalities, electrolyte disturbances, and hypothermia, which may prove fatal in patients with cardiac illness depending upon the severity. Additionally, cardiovascular complications are the major cause of adverse postoperative outcomes after liver transplantation even in the absence of cardiac pathologies. Clinical decision-making has remained an unsettled issue in these clinical scenarios. The absence of randomized clinical studies has further crippled our endeavours for a consensus on the management of patients with end-stage liver disease with cardiac illness. This review seeks to address this complex clinical setting by gathering information from published literature. The management algorithm in this review may facilitate clinical decision making and augur future research.

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