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A Propensity-matched Survival Analysis

Do Simultaneous Liver-lung Transplant Recipients Need a Liver?

Freischlag, Kyle1; Ezekian, Brian MD2; Schroder, Paul M. MD, PhD2; Mulvihill, Michael S. MD2; Cox, Morgan L. MD2; Hartwig, Matthew G. MD2; Knechtle, Stuart MD2

doi: 10.1097/TP.0000000000002529
Original Clinical Science—Liver

Background. There is debate whether simultaneous lung-liver transplant (LLT) long-term outcomes warrant allocation of 2 organs to a single recipient. We hypothesized that LLT recipients would have improved posttransplant survival compared with matched single-organ lung recipients with an equivalent degree of liver dysfunction.

Methods. The Organ Procurement and Transplant Network/United Network for Organ Sharing STAR file was queried for adult candidates for LLT and isolated lung transplantation from 2006 to 2016. Waitlist mortality and transplant odds were calculated for all candidates. Donor and recipient demographic characteristics were compiled and compared. The LLT recipients were matched 1:2 with a nearest neighbor method to single-organ lung recipients. Kaplan-Meier methods with log-rank test compared long-term survival between groups. Univariate regression was used to calculate the association of LLT and mortality within 6 months of transplant. A proportional hazards model was used to calculate risk-adjusted mortality after 6 months posttransplantation.

Results. Thirty-eight LLT patients were matched to 75 single-organ lung recipients. After matching, no differences in baseline demographics or liver function were observed between cohorts. Length of stay was significantly longer in LLT recipients compared to isolated lung recipients (45.89 days vs 22.44 days, P < 0.001). There was no significant difference in survival probability between LLT and isolated lung transplant (1 y, 89.5% vs 86.7%; 5 y, 67.0% vs 64.6%; P = 0.20).

Conclusions. After matching for patient characteristics and level of liver dysfunction, survival in simultaneous LLT was comparable to isolated lung transplantation. Although this population is unique, the clinical picture prompting liver transplant is not clear. National guidelines to better elucidate patient selection are needed.

1 School of Medicine, Duke University, Durham, NC.

2 Department of Surgery, Duke University Medical Center, Durham, NC.

Received 11 April 2018. Revision received 21 August 2018.

Accepted 18 September 2018.

The authors declare no funding or conflicts of interest.

Data contained in this article were accepted as a podium presentation at the Academic Surgical Congress in February 2018 in Jacksonville, Florida.

K.F. participated in research design, writing of the article, and data analysis. B.E. participated in the interpretation of data for the work and writing of the article. P.M.S. participated in the writing of the article and interpretation of data for the work. M.S.M. participated in the writing of the article and data analysis. M.L.C. participated in the conception and design of the work and writing of the article. M.G.H. participated in research design and writing of the article. S.K. participated in research design, writing of the article, and data analysis.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Kyle Freischlag, BA, DUMC 3512, Durham, NC 27710. (

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