Combined Lung and Liver Transplantation: Analysis of a Single-Center Experience

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), 1-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. (c) 2013 AASLD.