Multi-Organ Transplant in Cystic Fibrosis and its Impact on Long-Term Survival

Abstract

PurposeCystic fibrosis (CF) can lead to end stage lung disease for which lung transplantation can be a life-saving therapy. CF has systemic manifestations that can lead to other end organ damage. In addition, immune suppression following single organ transplantation has adverse effects including end stage renal disease. Multi-organ transplant in CF has had a significant impact on long-term survival of CF patients. In this study, we aim to assess the impact of multi-organ transplant on the survival of CF patients.MethodsThis is a retrospective review of all CF patients who have been multi-organ recipients after their initial lung transplant (March 1988 to July 2020). Lung re- transplant only were excluded.ResultsFrom 435 lung transplant recipients we identified 19 patients with CF who had received multi-organ transplant either simultaneously with the lung transplant or consecutively over time. 7 recipients received simultaneously 15 organs that included: 1 heart and lung, 5 lung and liver and 1 lung, liver, pancreas. The median survival for this group was: 8.9 years. 12 recipients received consecutively 30 organs that included: 6 lung followed by kidney transplant; 1 lung followed by liver transplant; 1 lung followed by combined kidney+liver; 1 lung followed by combined kidney + pancreas; 1 lung followed by liver and then kidney transplant; 1 lung transplant followed by a second lung transplant and later on kidney transplant and finally 1 lung followed by another lung transplant and later on combined kidney+ pancreas.The median survival of these multiorgan recipients is 14 years. The current median survival for CF patients in our program excluding re-transplants is 8.2 years.ConclusionLung transplant for CF offers survival benefit and improved quality of life, such that a subgroup of these patients qualify for a second and even a third organ transplant to further prolong life. Cystic fibrosis (CF) can lead to end stage lung disease for which lung transplantation can be a life-saving therapy. CF has systemic manifestations that can lead to other end organ damage. In addition, immune suppression following single organ transplantation has adverse effects including end stage renal disease. Multi-organ transplant in CF has had a significant impact on long-term survival of CF patients. In this study, we aim to assess the impact of multi-organ transplant on the survival of CF patients. This is a retrospective review of all CF patients who have been multi-organ recipients after their initial lung transplant (March 1988 to July 2020). Lung re- transplant only were excluded. From 435 lung transplant recipients we identified 19 patients with CF who had received multi-organ transplant either simultaneously with the lung transplant or consecutively over time. 7 recipients received simultaneously 15 organs that included: 1 heart and lung, 5 lung and liver and 1 lung, liver, pancreas. The median survival for this group was: 8.9 years. 12 recipients received consecutively 30 organs that included: 6 lung followed by kidney transplant; 1 lung followed by liver transplant; 1 lung followed by combined kidney+liver; 1 lung followed by combined kidney + pancreas; 1 lung followed by liver and then kidney transplant; 1 lung transplant followed by a second lung transplant and later on kidney transplant and finally 1 lung followed by another lung transplant and later on combined kidney+ pancreas.The median survival of these multiorgan recipients is 14 years. The current median survival for CF patients in our program excluding re-transplants is 8.2 years. Lung transplant for CF offers survival benefit and improved quality of life, such that a subgroup of these patients qualify for a second and even a third organ transplant to further prolong life.