School of Medicine, Duke University, Durham, NC.
Department of Surgery, Duke University Medical Center, Durham, NC.
Transplantation. 2019 Aug;103(8):1675-1682. doi: 10.1097/TP.0000000000002529.
There is debate whether simultaneous lung-liver transplant (LLT) long-term outcomes warrant allocation of 2 organs to a single recipient. We hypothesized that LLT recipients would have improved posttransplant survival compared with matched single-organ lung recipients with an equivalent degree of liver dysfunction.
The Organ Procurement and Transplant Network/United Network for Organ Sharing STAR file was queried for adult candidates for LLT and isolated lung transplantation from 2006 to 2016. Waitlist mortality and transplant odds were calculated for all candidates. Donor and recipient demographic characteristics were compiled and compared. The LLT recipients were matched 1:2 with a nearest neighbor method to single-organ lung recipients. Kaplan-Meier methods with log-rank test compared long-term survival between groups. Univariate regression was used to calculate the association of LLT and mortality within 6 months of transplant. A proportional hazards model was used to calculate risk-adjusted mortality after 6 months posttransplantation.
Thirty-eight LLT patients were matched to 75 single-organ lung recipients. After matching, no differences in baseline demographics or liver function were observed between cohorts. Length of stay was significantly longer in LLT recipients compared to isolated lung recipients (45.89 days vs 22.44 days, P < 0.001). There was no significant difference in survival probability between LLT and isolated lung transplant (1 y, 89.5% vs 86.7%; 5 y, 67.0% vs 64.6%; P = 0.20).
After matching for patient characteristics and level of liver dysfunction, survival in simultaneous LLT was comparable to isolated lung transplantation. Although this population is unique, the clinical picture prompting liver transplant is not clear. National guidelines to better elucidate patient selection are needed.
对于肺-肝联合移植（LLT）的长期效果是否值得分配 2 个器官给单个受者，目前存在争议。我们假设与具有同等程度肝功能障碍的匹配单肺受者相比，LLT 受者在移植后具有更好的生存结果。
从 2006 年至 2016 年，查询了器官获取和移植网络/联合器官共享网络 STAR 文件中成人候选者的 LLT 和孤立肺移植。计算了所有候选者的等待名单死亡率和移植几率。收集并比较了供体和受者的人口统计学特征。使用最近邻法将 LLT 受者与单器官肺受者 1:2 匹配。使用 Kaplan-Meier 方法和对数秩检验比较组间长期生存率。使用单变量回归计算 LLT 与移植后 6 个月内死亡率的关联。使用比例风险模型计算移植后 6 个月后风险调整的死亡率。
38 例 LLT 患者与 75 例单器官肺移植患者相匹配。匹配后，两组间基线人口统计学特征或肝功能无差异。与孤立肺移植受者相比，LLT 受者的住院时间明显更长（45.89 天比 22.44 天，P <0.001）。LLT 和孤立肺移植的生存率无显著差异（1 年，89.5%比 86.7%；5 年，67.0%比 64.6%；P = 0.20）。
在匹配患者特征和肝功能障碍程度后，同时进行 LLT 的生存情况与孤立肺移植相当。尽管这一人群是独特的，但促使进行肝移植的临床情况尚不清楚。需要制定国家指南以更好地阐明患者选择。
