Combined heart-lung-liver transplantation is feasible in certain patients


LONDON (Reuters Health) – While transplantation is usually performed in patients with single organ failure, a report published in the September 8th issue of The Lancet indicates that combined heart-lung-liver transplantation is feasible for patients with dual organ failure.

Dr. Peter J. Friend, from The Churchill Hospital in Oxford, UK, and colleagues reviewed the case records of nine patients who underwent combined heart-lung-liver transplantation in Cambridge between 1986 and 1999. Eight patients had end-stage lung disease and advanced liver disease and one patient had end-stage liver disease with compromised lung function. All but two patients had cystic fibrosis.

All patients received 3 days of anti-thymocyte globulin induction therapy followed by cyclosporin, azathioprine, and prednisolone maintenance therapy, the authors note. The perioperative antibiotic regimen for all patients included flucloxacillin and a third-generation cephalosporin. Cystic fibrosis patients also received nebulised colistin and tobramycin as well as treatment for Pseudomonas aeruginosa.

Two patients experienced episodes of pulmonary rejection and one patient had episodes of pulmonary and liver rejection, the investigators note. The acute and chronic rejection rate was actually lower than what is commonly reported with heart-lung transplantation, they add.

The 1-year and 5-year actuarial survival rates of the group were 56% and 42%, respectively, the researchers state. Three patients died within a month of transplantation and four patients died between 4 months and 12 years after transplantation.

"Combined transplantation of the heart, lung, and liver is a feasible and therapeutically effective procedure for a few selected patients" and it achieves 5-year survival rates that are similar to those of heart-lung transplantation, the authors note. It may be a particularly viable option for patients "with cystic fibrosis complicated by advanced liver disease," they add.

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