Combined liver-thoracic transplantation: single-center experience with introduction of the "Liver-first' principle

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 analysed. Single-center cLiThTx (04/2000-12/2015) were reviewed for: demographics, indications, surgical technique, complications, rejection, five-year patient survival. Results are reported as median(range). Fourteen consecutive patients underwent cLiThTx: 3 cLiHTx, 10 cLiLuTx, 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 ex-vivo 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 3 months posttransplant and successfully re-transplanted. One patient (cLiHTx) died 4 months posttransplant (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 posttransplant, the other successfully retransplanted. Estimated five-year patient survival is 90%. CLiThTx is safe with excellent short-/long-term surgical and immunological results. This article is protected by copyright. All rights reserved.

Jaar van publicatie:2016

BOF-keylabel:ja

IOF-keylabel:ja

BOF-publication weight:2

CSS-citation score:2

Authors from:Higher Education

Toegankelijkheid:Closed