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Single-Center Long-Term Analysis of Combined Liver-Lung Transplant Outcomes.

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Date
2018-05
Authors
Freischlag, Kyle William
Messina, Julia
Ezekian, Brian
Mulvihill, Michael S
Barbas, Andrew
Berg, Carl
Sudan, Debra
Reynolds, John
Hartwig, Matthew
Knechtle, Stuart
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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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Journal article
Permalink
https://hdl.handle.net/10161/18166
Published Version (Please cite this version)
10.1097/TXD.0000000000000785
Publication 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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Scholars@Duke

Barbas

Andrew Serghios Barbas

Associate Professor of Surgery
Berg

Carl Berg

Professor of Medicine
Ezekian

Brian Ezekian

Affiliate
Hartwig

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
Knechtle

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
Messina

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.
Mulvihill

Michael Mulvihill

House Staff
Reynolds

John Michael Reynolds

Professor of Medicine
Sudan

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
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