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 42years (17-63years). 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 exvivo 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 3months post-transplant and successfully retransplanted. One patient (cLiHTx) died 4months post-transplant (myocardial infarction). Follow-up was 4years (2months-16years). One liver and 5 pulmonary rejections occurred, all mild and reversible. Two patients developed bronchiolitis obliterans, one is clinically well 16years 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.