Combined Heart-Lung-Liver Transplantation for Patients With Cystic Fibrosis : The Australian Experience
Copyright © 2021 Elsevier Inc. All rights reserved..
BACKGROUND: Combined multivisceral transplantation has emerged as a therapeutic option for a select patient cohort; however, clinical decision-making remains complex and controversial. The aim of this study was to examine patient characteristics, operative complications, and long-term outcomes of all patients who have undergone combined heart-lung-liver transplantation (HLLTx) in Australia.
METHODS: In this study, we performed a retrospective analysis of all adult patients who have undergone combined HLLTx in Australia to date. Recipient clinical characteristics, waitlist, and transplant outcomes are described.
RESULTS: Eight adult patients have received HLLTx at a single Australian transplant center. Recipients of HLLTx have typically been young (median age, 30.1 years; range, 24-37), underweight (median body mass index, 19.8 kg/m2; range, 16.2-30.4) patients with cystic fibrosis (n = 8, 100%) with severe airflow obstruction (median forced expiratory volume in the first second of expiration, 24% predicted; range, 17%-48%) accompanied by liver cirrhosis confirmed on histopathology (n = 8, 100%). Despite relative preservation of synthetic function and low model for end-stage liver disease scores (median, 8; range, 6-17), all recipients had complications of portal hypertension prior to transplantation, with many patients having suffered life-threatening variceal hemorrhage. In this cohort, HLLTx was associated with overall posttransplant survival of 87.5% at 30 days, 71.4% at 1 year, and 42.9% at 5 years. Listing for combined HLLTx was associated with prolonged waitlist times relative to bilateral sequential single-lung transplantation (median 556 vs 56 days, respectively), however waitlist mortality and/or delisting was comparable between groups.
CONCLUSIONS: Taken together, these findings highlight the opportunities and challenges facing combined (heart-) lung and liver transplantation in patients with multiorgan failure.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:53 |
|---|---|
| Enthalten in: |
Transplantation proceedings - 53(2021), 7 vom: 16. Sept., Seite 2382-2389 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bell, P T [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 25.11.2021 Date Revised 25.11.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.transproceed.2021.07.028 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM329563599 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM329563599 | ||
| 003 | DE-627 | ||
| 005 | 20231225205402.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.transproceed.2021.07.028 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1098.xml |
| 035 | |a (DE-627)NLM329563599 | ||
| 035 | |a (NLM)34412912 | ||
| 035 | |a (PII)S0041-1345(21)00518-2 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bell, P T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Combined Heart-Lung-Liver Transplantation for Patients With Cystic Fibrosis |b The Australian Experience |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.11.2021 | ||
| 500 | |a Date Revised 25.11.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Combined multivisceral transplantation has emerged as a therapeutic option for a select patient cohort; however, clinical decision-making remains complex and controversial. The aim of this study was to examine patient characteristics, operative complications, and long-term outcomes of all patients who have undergone combined heart-lung-liver transplantation (HLLTx) in Australia | ||
| 520 | |a METHODS: In this study, we performed a retrospective analysis of all adult patients who have undergone combined HLLTx in Australia to date. Recipient clinical characteristics, waitlist, and transplant outcomes are described | ||
| 520 | |a RESULTS: Eight adult patients have received HLLTx at a single Australian transplant center. Recipients of HLLTx have typically been young (median age, 30.1 years; range, 24-37), underweight (median body mass index, 19.8 kg/m2; range, 16.2-30.4) patients with cystic fibrosis (n = 8, 100%) with severe airflow obstruction (median forced expiratory volume in the first second of expiration, 24% predicted; range, 17%-48%) accompanied by liver cirrhosis confirmed on histopathology (n = 8, 100%). Despite relative preservation of synthetic function and low model for end-stage liver disease scores (median, 8; range, 6-17), all recipients had complications of portal hypertension prior to transplantation, with many patients having suffered life-threatening variceal hemorrhage. In this cohort, HLLTx was associated with overall posttransplant survival of 87.5% at 30 days, 71.4% at 1 year, and 42.9% at 5 years. Listing for combined HLLTx was associated with prolonged waitlist times relative to bilateral sequential single-lung transplantation (median 556 vs 56 days, respectively), however waitlist mortality and/or delisting was comparable between groups | ||
| 520 | |a CONCLUSIONS: Taken together, these findings highlight the opportunities and challenges facing combined (heart-) lung and liver transplantation in patients with multiorgan failure | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Carew, A |e verfasserin |4 aut | |
| 700 | 1 | |a Fiene, A |e verfasserin |4 aut | |
| 700 | 1 | |a Divithotawela, C |e verfasserin |4 aut | |
| 700 | 1 | |a Stuart, K A |e verfasserin |4 aut | |
| 700 | 1 | |a Hodgkinson, P |e verfasserin |4 aut | |
| 700 | 1 | |a Chambers, D C |e verfasserin |4 aut | |
| 700 | 1 | |a Hopkins, P M |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Transplantation proceedings |d 1969 |g 53(2021), 7 vom: 16. Sept., Seite 2382-2389 |w (DE-627)NLM000011029 |x 1873-2623 |7 nnns |
| 773 | 1 | 8 | |g volume:53 |g year:2021 |g number:7 |g day:16 |g month:09 |g pages:2382-2389 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.transproceed.2021.07.028 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 53 |j 2021 |e 7 |b 16 |c 09 |h 2382-2389 | ||