Dunbar Emily G, Kwon Ye In Christopher, Ambrosio Matthew, Tchoukina Inna F, Shah Keyur B, Bruno David A, Julliard Walker A, Chery Josue, Kasirajan Vigneshwar, Hashmi Zubair A
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, Virginia.
JHLT Open. 2024 Nov 8;7:100179. doi: 10.1016/j.jhlto.2024.100179. eCollection 2025 Feb.
As triple-organ transplantation (TOT) has become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT.
This retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-kidney-liver (HKL), and heart-kidney-pancreas (HKP) recipients from the United Network for Organ Sharing registry between 1989 and 2023. Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Recipient survival up to 10 years was analyzed using the Kaplan-Meier method.
During the study period, 81 TOTs were performed (13 HLLs, 13 HLKs, 46 HKLs, and 9 HKPs). There were no statistically significant differences in long-term survival between TOTs ( = 0.13). However, HLL and HLK recipients had significantly worse ( 0.0001) and improved ( 0.0001) survival, respectively, when compared to heart-lung, isolated heart, and lung transplant recipients. HLK was associated with improved survival (hazard ratios [HR]: 0.22, = 0.033). We found no differences in survival among HKL ( = 0.24) and HKP ( = 0.19) recipients compared to their dual- and single-organ counterparts. TOTs after 2007 (HR: 0.29, = 0.003) were associated with improved survival, whereas increased recipient age (HR: 1.06, = 0.037), estimated glomerular filtration rate (HR: 1.02, = 0.005), and donor age (HR:1.05, = 0.031) were associated with higher mortality.
The prevalence of TOTs has dramatically increased over the past decade. While overall survival between TOTs appears similar, adding a liver to a heart-lung transplant may be associated with a poorer prognosis compared to adding a kidney. A careful, multidisciplinary approach to patient selection and management remains paramount in optimizing outcomes for high-risk patients undergoing TOTs.
随着多器官移植（TOT）越来越普遍，我们评估了接受胸腹多器官移植患者的特征、危险因素及临床结局。
这项回顾性研究使用了1989年至2023年间器官共享联合网络登记处中心肺肝（HLL）、心肺肾（HLK）、心肝肾（HKL）及心肾胰（HKP）受者的数据。使用Cox回归风险模型分析受者和供者的特征及死亡危险因素。采用Kaplan-Meier法分析受者长达10年的生存率。
在研究期间，共进行了81例多器官移植（13例心肺肝移植、13例心肺肾移植、46例心肝肾移植和9例心肾胰移植）。多器官移植之间的长期生存率无统计学显著差异（P = 0.13）。然而，与心肺移植、单纯心脏移植和肺移植受者相比，心肺肝移植受者的生存率显著更差（P < 0.0001），而心肺肾移植受者的生存率则显著改善（P < 0.0001）。心肺肾移植与生存率改善相关（风险比[HR]：0.22，P = 0.033）。我们发现，与双器官和单器官移植受者相比，心肝肾移植（P = 0.24）和心肾胰移植（P = 0.19）受者的生存率没有差异。2007年后的多器官移植（HR：0.29，P = 0.003）与生存率改善相关，而受者年龄增加（HR：1.06，P = 0.037）、估计肾小球滤过率（HR：1.02，P = 0.005）和供者年龄（HR：１.05，P = 0.031）与更高的死亡率相关。
在过去十年中，多器官移植的患病率显著增加。虽然多器官移植之间的总体生存率似乎相似，但与增加一个肾脏相比，心肺移植中增加一个肝脏可能与更差的预后相关。对于接受多器官移植的高危患者，谨慎的多学科患者选择和管理方法对于优化结局仍然至关重要。
