Single-Center Long-Term Analysis of Combined Liver-Lung Transplant Outcomes.
Abstract
Background:Combined lung-liver transplantation (LLT) applies 2 technically challenging
transplants in 1 patient with severe 2-organ failure. Methods:Institutional medical
records and United Network for Organ Sharing database were queried for patients at
our institution that underwent LLT from 2000 to 2016. Results:Twelve LLTs were performed
from 2000 to 2016 including 9 male and 3 female recipients with a median age of 28.36
years. Indications for lung transplantation were cystic fibrosis (8), idiopathic pulmonary
fibrosis (3), and pulmonary fibrosis secondary to hepatopulmonary syndrome (1). Indications
for liver transplantation were cystic fibrosis (8), alcoholic cirrhosis (1), idiopathic
cirrhosis (2), and alpha-1 antitrypsin deficiency (1). Median forced expiratory volume
in 1 second at transplant was 27.8% (±20.38%), and mean Model for End-Stage Liver
Disease was 10.5 (±4.68). Median hospital stay was 44.5 days. Seventy-five percent
of recipients had 1+ new infection during their transplant hospitalization. Patients
experienced 0.68 incidences of acute rejection per year with a 41.7% (95% confidence
interval, 21.3%-81.4%) probability of freedom from rejection in the first-year. Patient
survival was 100% at 30 days, 91.6% at 1 year, and 71.3% at 3 years. At the time of
analysis, 7 of 12 patients were alive, of whom 3 survived over 8 years post-LLT. Causes
of death were primary liver graft failure (1), bronchiolitis obliterans syndrome (2),
and solid tumor malignancies (2). Conclusions:Our results indicate that LLT is associated
with comparable survival to other LLT series and provides a granular assessment of
infectious and rejection rates in this rare population.
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https://hdl.handle.net/10161/18166Published Version (Please cite this version)
10.1097/TXD.0000000000000785Publication Info
Freischlag, Kyle William; Messina, Julia; Ezekian, Brian; Mulvihill, Michael S; Barbas,
Andrew; Berg, Carl; ... Knechtle, Stuart (2018). Single-Center Long-Term Analysis of Combined Liver-Lung Transplant Outcomes. Transplantation direct, 4(5). pp. e349. 10.1097/TXD.0000000000000785. Retrieved from https://hdl.handle.net/10161/18166.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Andrew Serghios Barbas
Associate Professor of Surgery
Carl Berg
Professor of Medicine
Brian Ezekian
Affiliate
Matthew Hartwig
Professor of Surgery
Dr. Hartwig is a thoracic surgeon with a clinical focus in robotic assisted minimally
invasive thoracic surgery for the treatment of diseases of the chest. He serves as
the Surgical Director of the Esophageal Center at Duke. He is also the Director of
the Minimally Invasive Thoracic Surgery Fellowship at Duke, while providing advanced
instruction in robotic surgery to surgeons around the world. He also leads a successful
program of clinical, basic and translational research in tho
Stuart Johnston Knechtle
William R. Kenan, Jr. Distinguished Professor
During my career as an academic surgeon, I have had the privilege of leading and/or
participating in a diverse portfolio of hypothesis-driven research projects. These
projects have centered on the immunology of surgery and transplantation, including
both cellular and antibody-mediated immune responses. During my training I studied
the response of hyper-sensitized recipients to allogeneic liver transplantation, and
am currently studying means of reducing immunologic memory that might
Julia Antoinette Messina
Assistant Professor of Medicine
I am a Transplant Infectious Diseases Physician who specializes in the care of immunocompromised
patients including solid organ and bone marrow transplant recipients and patients
with HIV. My research interests are in infections and clinical outcomes in patients
with hematologic malignancies.
Michael Mulvihill
House Staff
John Michael Reynolds
Professor of Medicine
Debra L Sudan
Professor of Surgery
I am interested clinically in all abdominal organ transplants (kidney, liver, pancreas
and intestine). I am specifically interested in intestine transplantation and improving
intestine graft preservation and long-term graft function and patient survival. In
addition, I am interested in monitoring of patients to improve our ability to determine
the etiology of graft dysfunction when there are complex interacting issues such as
infection and rejection as well as examining better immuno
Alphabetical list of authors with Scholars@Duke profiles.

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