Connor Ashton A, Huang Howard J, Mobley Constance M, Graviss Edward A, Nguyen Duc T, Goodarzi Ahmad, Saharia Ashish, Yau Simon, Hobeika Mark J, Suarez Erik E, Moaddab Mozhgon, Brombosz Elizabeth W, Moore Linda W, Yi Stephanie G, Gaber A Osama, Ghobrial Rafik Mark
JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX.
Department of Surgery, Houston Methodist Hospital, Houston, TX.
Transplant Direct. 2023 Apr 20;9(5):e1482. doi: 10.1097/TXD.0000000000001482. eCollection 2023 May.
Combined liver-lung transplantation is an uncommon, although vital, procedure for patients with simultaneous end-stage lung and liver disease. The utility of lung-liver transplant has been questioned because of initial poor survival outcomes, particularly when compared with liver-alone transplant recipients.
A single-center, retrospective review of the medical records of 19 adult lung-liver transplant recipients was conducted, comparing early recipients (2009-2014) with a recent cohort (2015-2021). Patients were also compared with the center's single lung or liver transplant recipients.
Recent lung-liver recipients were older ( = 0.004), had a higher body mass index ( = 0.03), and were less likely to have ascites ( = 0.02), reflecting changes in the etiologies of lung and liver disease. Liver cold ischemia time was longer in the modern cohort ( = 0.004), and patients had a longer posttransplant length of hospitalization ( = 0.048). Overall survival was not statistically different between the 2 eras studied ( = 0.61), although 1-y survival was higher in the more recent group (90.9% versus 62.5%). Overall survival after lung-liver transplant was equivalent to lung-alone recipients and was significantly lower than liver-alone recipients (5-y survival: 52%, 51%, and 75%, respectively). Lung-liver recipient mortality was primarily driven by deaths within 6 mo of transplant due to infection and sepsis. Graft failure was not significantly different (liver: = 0.06; lung: = 0.74).
The severity of illness in lung-liver recipients combined with the infrequency of the procedure supports its continued use. However, particular attention should be paid to patient selection, immunosuppression, and prophylaxis against infection to ensure proper utilization of scarce donor organs.
联合肝肺移植对于同时患有终末期肺病和肝病的患者来说是一种不常见但至关重要的手术。由于最初的生存结果较差，尤其是与单纯肝移植受者相比，肺肝移植的效用受到了质疑。
对19例成年肺肝移植受者的病历进行单中心回顾性研究，将早期受者（2009 - 2014年）与近期队列（2015 - 2021年）进行比较。患者还与该中心的单肺或肝移植受者进行了比较。
近期肺肝移植受者年龄更大（P = 0.004），体重指数更高（P = 0.03），且腹水发生率更低（P = 0.02），这反映了肺和肝病病因的变化。现代队列中肝脏冷缺血时间更长（P = 0.004），患者移植后住院时间更长（P = 0.048）。在所研究的两个时期之间，总体生存率无统计学差异（P = 0.61），尽管近期组的1年生存率更高（90.9%对62.5%）。肺肝移植后的总体生存率与单肺移植受者相当，且显著低于单纯肝移植受者（5年生存率分别为：52%、51%和75%）。肺肝移植受者的死亡主要由移植后6个月内的感染和败血症导致。移植物失败无显著差异（肝脏：P = 0.06；肺：P = 0.74）。
肺肝移植受者病情的严重性以及该手术的罕见性支持其继续应用。然而，应特别关注患者选择、免疫抑制和感染预防，以确保稀缺供体器官的合理利用。
