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Conquering combined thoracic organ and liver transplantation

indications and outcomes for heart-liver and lung–liver transplantation

Yi, Stephanie G.a,b; Lunsford, Keri E.a,b,c; Bruce, Courtenayd; Ghobrial, R. Marka,b

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 180–186
doi: 10.1097/MOT.0000000000000509
LIVER TRANSPLANTATION: Edited by R. Mark Ghobrial
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Purpose of review Combined thoracic organ and liver transplantation has been shown to be a viable treatment option for patients with end-stage disease lung or heart and disease. There are increasing number of cases reported in the literature, as the number of institutions utilizing this strategy is growing. Herein, we review the current literature of combined thoracic and liver transplantation.

Recent findings A larger number of combined heart or lung and liver transplants (CHLT and CLLT) are being performed. A recent literature search showed approximately 231 CHLT and 89 CLLT and being described. One-year patient survival ranged from 71 to 80% for CLLT and 80–93% for CHLT, respectively. Indications for combined transplant and disease-specific outcomes are still being evaluated. Additionally, salvage modalities such as extracorporeal membrane oxygenation and ex-vivo lung perfusion are also being described.

Summary Combined thoracic and liver transplant continues to be a viable treatment option for patients with end-stage disease that would likely not survive single transplant alone. Salvage modalities, such as extracorporeal membrane oxygenation and ex-vivo lung perfusion, may help in extending candidacy for this combined transplant. Outcomes, to date, are similar to results observed for solitary thoracic organ recipients, justifying CHLT and CLLT as a viable option for these patients. Continued identification of outcomes is needed to justify allocation of dual organs to a single recipient.

aWeill Cornell Medical College

bJ.C. Walter Jr. Center for Transplantation, Houston Methodist Hospital, Houston, TX

cDepartment of Surgery, Immunobiology and Transplant Science Center, Houston Methodist Hospital and Research Institute

dBiomedical Ethics Program, Houston Methodist Hospital, Houston, Texas, USA

Correspondence to Keri E. Lunsford, MD, PhD, Weill Cornell Medical College, Houston, TX; Department of Surgery, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Immunobiology and Transplant Science Center, J.C. Walter Jr. Center for Transplantation, Houston Methodist Hospital and Research Institute, 6550 Fannin Street, Suite 1661, Houston, TX 77030, USA. Tel: +1 713 441 2038; fax: +1 713 791 5109; e-mail: klunsford@houstonmethodist.org

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