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Liver-first strategy for a combined lung and liver transplant in patients with cystic fibrosis

A combined lung and liver transplant in patients with cystic fibrosis (CF) is an uncommon procedure. The goal of this study was to compare long-term outcomes between patients with CF who underwent either a combined lung-liver or a lung-only transplant.This is a retrospective single-centre study of p...

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Main Authors: Aburahma, Khalil (Author) , Salman, Jawad (Author) , Engel, Bastian (Author) , Vondran, Florian W R (Author) , Greer, Mark (Author) , Boethig, Dietmar (Author) , Siemeni, Thierry (Author) , Avsar, Murat (Author) , Schwerk, Nicolaus (Author) , Müller, Carsten (Author) , Taubert, Richard (Author) , Hoeper, Marius M (Author) , Welte, Tobias (Author) , Wedemeyer, Hans H (Author) , Richter, Nicolas (Author) , Warnecke, Gregor (Author) , Tudorache, Igor (Author) , Haverich, Axel (Author) , Kuehn, Christian (Author) , Grannas, Gerrit (Author) , Ius, Fabio (Author)
Format: Article (Journal)
Language:English
Published: 06 May 2021
In: European journal of cardio-thoracic surgery
Year: 2021, Volume: 60, Issue: 4, Pages: 822-830
ISSN:1873-734X
DOI:10.1093/ejcts/ezab164
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1093/ejcts/ezab164
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Author Notes:Khalil Aburahma, Jawad Salman, Bastian Engel, Florian W.R. Vondran, Mark Greer, Dietmar Boethig, Thierry Siemeni, Murat Avsar, Nicolaus Schwerk, Carsten Müller, Richard Taubert, Marius M. Hoeper, Tobias Welte, Hans H. Wedemeyer, Nicolas Richter, Gregor Warnecke, Igor Tudorache, Axel Haverich, Christian Kuehn, Gerrit Grannas, and Fabio Ius
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Summary:A combined lung and liver transplant in patients with cystic fibrosis (CF) is an uncommon procedure. The goal of this study was to compare long-term outcomes between patients with CF who underwent either a combined lung-liver or a lung-only transplant.This is a retrospective single-centre study of patients with CF who underwent a lung transplant between January 2005 and May 2020. Since 2006, our preference for a combined lung-liver transplant was to transplant the liver first and then the lung. Outcomes were compared using the Kaplan-Meier analysis and the log-rank test. Median follow-up was 53 (23-97) months.During the study period, among 357 patients with CF who underwent a lung transplant, 14 (4%) required a lung-liver transplant whereas 343 (96%) had a lung-only transplant. Lung cold ischaemic time was longer in the lung-liver transplant group, but no patient in this group showed primary graft dysfunction at 72 h after the transplant. Prevalence of anti-human leucocyte antigen donor-specific antibodies was 7.1% vs 13.7% in the lung-liver versus the lung-only transplant group (P = 0.42). At 5 years, lung graft survival (78% vs 69%) and freedom from chronic lung allograft dysfunction (79% vs 62%) did not differ between the lung-liver versus the lung-only groups (P = 0.45 and P = 0.55, respectively). Freedom from lung biopsy-confirmed rejection was significantly higher in patients undergoing a lung-liver transplant (91% vs 50%; P = 0.027).A lung-liver transplant did not impair lung graft function. The lower prevalence of donor-specific antibodies and the better freedom from lung biopsy-confirmed rejection suggest tolerogenic effects of the liver graft.
Item Description:Gesehen am 03.05.2022
Physical Description:Online Resource
ISSN:1873-734X
DOI:10.1093/ejcts/ezab164

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