Wilson Renita, Jenkins J Asher, Farina Juan Maria, Langlais Blake, Aqel Bashar, Omar Ashraf, D'Cunha Jonathan, Dos Santos Pedro Reck
Mayo Clinic Alix School of Medicine, Phoenix, Arizona.
Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
JHLT Open. 2024 Dec 20;7:100200. doi: 10.1016/j.jhlto.2024.100200. eCollection 2025 Feb.
Concomitant abdominal organ transplant of the liver, kidney, and/or pancreas with lung transplant (Con-AbLTx) may be considered for appropriate patients who present with end-stage disease of multiple organ systems. Most existing literature examines outcomes of combined lung-liver transplants, with little attention paid to other commonly transplanted abdominal organs, such as kidneys and pancreas. This study aims to examine post-transplant outcomes of patients submitted to Con-AbLTx to lung transplant (LTx)-only recipients.
The international society for heart and lung transplantation (ISHLT) International Thoracic Organ Transplant Registry for Con-AbLTx and LTx-only was reviewed from January 1994 to June 2018. LTx-only recipients were propensity score matched 4:1 based on various patient characteristics. Data were analyzed with Fisher's exact, Wilcoxon rank sum tests, Kaplan-Meier methods, and Cox proportional hazards where appropriate.
A total of 195 Con-AbLTx and 780 propensity-matched LTx-only cases were compared. LTx-only recipients demonstrated higher levels of bronchiolitis obliterans syndrome. Following transplant, Con-AbLTx required a longer hospital stay and post-transplant dialysis before discharge. LTx-only were more likely to experience graft failure from acute rejection or chronic rejection. Con-AbLTx experienced higher 1-year mortality than LTx-only counterparts, with the highest mortality seen in the concomitant lung/kidney group. Of concomitant transplants, lung/liver recipients had greater survival over time.
Con-AbLTx has the potential to carry substantial morbidity. At 10 years post-transplant, there is no statistically significant difference in survival between LTx-only and Con-AbLTx recipients. Given limited organ availability and ethical considerations of simultaneous transplant, careful consideration for Con-AbLTx is paramount to achieve acceptable outcomes.
对于出现多器官系统终末期疾病的合适患者，可考虑同时进行肝脏、肾脏和/或胰腺与肺移植的腹部器官联合移植（Con-AbLTx）。大多数现有文献研究的是肺-肝联合移植的结果，很少关注其他常见的移植腹部器官，如肾脏和胰腺。本研究旨在探讨接受Con-AbLTx的患者与仅接受肺移植（LTx）的受者相比的移植后结局。
回顾了国际心肺移植学会（ISHLT）1994年1月至2018年6月的国际胸部器官移植登记处中Con-AbLTx和仅LTx的数据。仅LTx的受者根据各种患者特征按1:4的倾向评分进行匹配。在适当情况下，使用Fisher精确检验、Wilcoxon秩和检验、Kaplan-Meier方法和Cox比例风险模型对数据进行分析。
共比较了195例Con-AbLTx和780例倾向匹配的仅LTx病例。仅LTx的受者闭塞性细支气管炎综合征水平较高。移植后，Con-AbLTx患者住院时间更长，出院前需要进行移植后透析。仅LTx的患者更有可能因急性排斥或慢性排斥而发生移植物失败。Con-AbLTx患者的1年死亡率高于仅LTx的患者，其中肺/肾联合移植组的死亡率最高。在联合移植中，肺/肝受者随时间推移的生存率更高。
Con-AbLTx可能会带来较高的发病率。移植后10年，仅LTx和Con-AbLTx受者的生存率在统计学上无显著差异。鉴于器官供应有限以及同时移植的伦理考虑，对Con-AbLTx进行仔细考虑对于获得可接受的结果至关重要。
