K. Freischlag1, B. Ezekian2, M. S. Mulvihill2, P. M. Schroder2, H. Leraas1, S. Knechtle2 1Duke University Medical Center,School Of Medicine,Durham, NC, USA 2Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction:
There is debate in the field of transplantation as to whether simultaneous lung-liver transplant (LLT) long-term outcomes warrant allocation of two organs to a single recipient. We hypothesized that LLT recipients would have improved survival compared to single-organ lung recipients with a similar degree of liver dysfunction and tested this question using a large national database.
Methods:
The OPTN/UNOS STAR file was queried for adult recipients of LLT and isolated lung transplant from 2006-2016. Demographic characteristics were subsequently generated and examined. LLT recipients were respectively matched 1:2 with single-organ lung recipients on age, gender, ethnicity, number of previous transplants, diagnosis, diabetes status, BMI, donor BMI, calculated MELDXI, LAS, and year of transplant. Kaplan-Meier analysis with the log-rank test compared survival between groups.
Results:
A total of 18,273 lung recipients were identified. Of those, 43 patients underwent simultaneous LLT. In an unadjusted comparison of the LLT recipients with the isolated lung transplant recipients after the introduction of the lung allocation score (LAS), the LLT recipients were younger (34.19 years vs 54.74 years, p<0.001), had a lower BMI (20.83 vs 25.02, p<0.001), had a lower donor BMI (23.26 vs 25.86, p=0.001), had a higher percentage of diabetics (44.5% vs 19.5%, p<0.001), had a lower FEV1 (27.78 vs 38.16, p<0.001), higher percentage of cystic fibrosis patients (62.8% vs 11.9%, p<0.001), and had higher MELDXI (11.95 vs 9.95, p<0.001). Forty-one LLT patients were matched to eighty-two single-organ lung recipients with no differences in baseline characteristics and similar liver dysfunction. Overall survival was not significantly different between matched lung alone and LLT (Figure 1: 1-year 92.6% vs 87.8%, 5-year 62.6% vs 66.7%, 10-year 39.6% vs 43.1%, p=0.29).
Conclusion:
Survival in combined LLT was comparable to isolated lung transplantation, even after matching for patient characteristics and level of liver dysfunction. Thus, this analysis failed to identify a cohort of patients that benefit significantly from LLT. In order to continue this practice, further studies must identify a cohort of patients with dual organ failure that are most likely to benefit from this strategy.
