Background: While rare, combined Thoracic/Liver transplants are employed with increasing frequency. Consistent data regarding the technical conduct, patient selection and outcomes in this highly complex group is lacking.

Methods: Patients with end stage cardiac/pulmonary and liver disease who underwent heart-liver (HL) or lung-liver (LL) transplantation were evaluated. Transplants were performed sequentially (thoracic-first approach.) Liver pre-operative pathology were reviewed. (12 consecutive patients, 3 LL and 9 HL tx , 2010-2017, retrospective, single center)

Results: Age was 34.8±13.8 years. Median MELD was 12.5 (range 8-40). 56% of HL were secondary to congenital cardiac defects. Median patient follow up was 17 months (range 8-90). Patient survival was 100%. Graft survival was 96%. One graft failure from HAT required re-do liver tx on POD 22. 9 patients had pre-tx liver biopsy (8 with cirr/bridging fibr.) Amongst LL recipients there was one case of ACR (liver and lung). For HL, 3 patients had ≥ 1 episode of ACR (33%), 2 developed AMR (22%) in the heart. One patient had ACR in the liver allograft (11%)

Conclusions: Thoracic/Liver tx have excellent short-term graft and patient survival. Congenital heart disease with cardiac failure and cirrhosis represents a growing indication for HL tx. hTERc mutations is an emerging etiology for LL tx. Establishing the degree of pre-transplant liver disease is crucial to prevent inappropriate allocation of these life-saving organs.

CITATION INFORMATION: Presser N., DiNorcia J., Agopian V., Yersiz H., Farmer D., Busuttil R., Kaldas F. Complex Combined Thoracic/liver Transplant: A Seven Year Experience Am J Transplant. 2017;17 (suppl 3).

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