Concomitant abdominal organ transplantation alongside lung transplantation: An ISHLT transplant database analysis

Background

Concomitant abdominal organ transplant of the liver, kidney, and/or pancreas with lung transplant (Con-AbLTx) may be considered for appropriate patients who present with end-stage disease of multiple organ systems. Most existing literature examines outcomes of combined lung-liver transplants, with little attention paid to other commonly transplanted abdominal organs, such as kidneys and pancreas. This study aims to examine post-transplant outcomes of patients submitted to Con-AbLTx to lung transplant (LTx)-only recipients.

Methods

The international society for heart and lung transplantation (ISHLT) International Thoracic Organ Transplant Registry for Con-AbLTx and LTx-only was reviewed from January 1994 to June 2018. LTx-only recipients were propensity score matched 4:1 based on various patient characteristics. Data were analyzed with Fisher’s exact, Wilcoxon rank sum tests, Kaplan-Meier methods, and Cox proportional hazards where appropriate.

Results

A total of 195 Con-AbLTx and 780 propensity-matched LTx-only cases were compared. LTx-only recipients demonstrated higher levels of bronchiolitis obliterans syndrome. Following transplant, Con-AbLTx required a longer hospital stay and post-transplant dialysis before discharge. LTx-only were more likely to experience graft failure from acute rejection or chronic rejection. Con-AbLTx experienced higher 1-year mortality than LTx-only counterparts, with the highest mortality seen in the concomitant lung/kidney group. Of concomitant transplants, lung/liver recipients had greater survival over time.

Conclusions

Con-AbLTx has the potential to carry substantial morbidity. At 10 years post-transplant, there is no statistically significant difference in survival between LTx-only and Con-AbLTx recipients. Given limited organ availability and ethical considerations of simultaneous transplant, careful consideration for Con-AbLTx is paramount to achieve acceptable outcomes.