Sequential Liver, Kidney, and Heart Transplantation in a Single Recipient: Long-Term Survival Complicated by Chronic Renal Allograft Failure, Lung Cancer, and Recurrent Infection-A Case Report.

Abstract

Background: Multi-organ transplant recipients face a substantial long-term risk of infection, malignancy, and chronic rejection secondary to prolonged immunosuppression. Sequential liver, kidney, and heart transplantations remain rare, resulting in limited evidence to guide perioperative management and long-term follow-up.

Case summary: A 61-year-old man underwent sequential liver, kidney, and heart transplantations in 2012, 2018, and 2022, respectively. Initial graft function was favorable under an immunosuppressive regimen comprising tacrolimus, mycophenolate mofetil, and corticosteroids. From 2023 onwards, he developed recurrent SARS-CoV-2 infections, lung cancer requiring a segmentectomy, recurrent lower-extremity arteriosclerosis obliterans, and progressive renal allograft failure. He ultimately died from cardiopulmonary arrest precipitated by severe metabolic acidosis and electrolyte derangements complicating renal allograft failure.

Discussion: This case suggests that patients undergoing sequential multi-organ transplantations can achieve meaningful long-term survival with multidisciplinary care and individualized immunosuppression. Nevertheless, complications related to cumulative immunosuppression remain a major challenge, necessitating dynamic follow-up and tailored post-transplant management.

Conclusion: Sequential liver, kidney, and heart transplantations are feasible in carefully selected patients. However, the delayed adverse effects of chronic immunosuppression pose a major threat to long-term outcomes, underscoring the absolute necessity for vigilant monitoring and highly individualized pharmacological management.