Liver-first versus lung-first: a new dilemma in combined organ transplantation

Ceulemans, Laurens J.; Vos, Robin; Neyrinck, Arne; Pirenne, Jacques; Warnecke, G.; Raemdonck, Dirk Van

doi:10.1111/tri.13099

Cited by 7 publications

(2 citation statements)

References 8 publications

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“…Liver-first versus lung-first strategy is still under debate. 42 Surgical techniques for CLLT and lung-only transplant have been previously reported by Grannas et al and Salman et al 43,44 At the Broussais Hospital, all operations involving patients with CF from 1989 to 1995 were performed on CPB due to the critical nature of the recipient's condition (all patients required supplemental oxygen before undergoing transplantation); liver transplantation was performed after completion of lung implantation and termination of bypass. 45 In recent years, ECMO has become the mainstay of cardiopulmonary support during lung transplantation, reducing the need for anticoagulation and thus bleeding complications and blood transfusions.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Combined Organ Transplantation in Patients with Advanced Liver Disease

Zhang,

Lurje,

Lurje

et al. 2024

Semin Liver Dis

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Transplantation of the liver in combination with other organs is an increasingly performed procedure. Over the years, continuous improvement in survival could be realized through careful patient selection and refined organ preservation techniques, in spite of the challenges posed by aging recipients and donors, as well as the increased use of steatotic liver grafts. Herein, we revisit the epidemiology, allocation policies in different transplant zones, indications, and outcomes with regard to simultaneous organ transplants involving the liver, that is combined heart–liver, liver–lung, liver–kidney, and multivisceral transplantation. We address challenges surrounding combined organ transplantation such as equity, utility, and logistics of dual organ implantation, but also advantages that come along with combined transplantation, thereby focusing on molecular mechanisms underlying immunoprotection provided by the liver to the other allografts. In addition, the current standing and knowledge of machine perfusion in combined organ transplantation, mostly based on center experience, will be reviewed. Notwithstanding all the technical advances, shortage of organs, and the lack of universal eligibility criteria for certain multi-organ combinations are hurdles that need to be tackled in the future.

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Section: Surgical Proceduresmentioning

confidence: 99%

Combined Organ Transplantation in Patients with Advanced Liver Disease

Zhang,

Lurje,

Lurje

et al. 2024

Semin Liver Dis

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“…Longer preservation times allow broader geographic lung sharing, mitigate time constraints during multiorgan transplant, and may allow EVLP centralization. 91,[106][107][108] Indeed, some centralized EVLP facilities are already established. Ideally, all initially declined lungs would be gathered in one place, screened to determine their transplantability, then reallocated to potential transplant candidates.…”

Section: Current Role Of Evlp For Marginal Donor Screeningmentioning

confidence: 99%

Expanding Donor Options for Lung Transplant: Extended Criteria, Donation After Circulatory Death, ABO Incompatibility, and Evolution of Ex Vivo Lung Perfusion

et al. 2023

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Only using brain-dead donors with standard criteria, the existing donor shortage has never improved in lung transplantation. Currently, clinical efforts have sought the means to use cohorts of untapped donors, such as extended criteria donors, donation after circulatory death, and donors that are ABO blood group incompatible, and establish the evidence for their potential contribution to the lung transplant needs. Also, technical maturation for using those lungs may eliminate immediate concerns about the early posttransplant course, such as primary graft dysfunction or hyperacute rejection. In addition, recent clinical and preclinical advances in ex vivo lung perfusion techniques have allowed the safer use of lungs from high-risk donors and graft modification to match grafts to recipients and may improve posttransplant outcomes. This review summarizes recent trends and accomplishments and future applications for expanding the donor pool in lung transplantation.

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