*Purpose: Combined liver-lung transplantation (CLLT) is indicated in patients who cannot survive single-organ transplantation alone. Ex-situ normothermic machine perfusion (NMP) has been used to increase the pool of suboptimal donors and has been previously used for extended normothermic lung preservation in CLLT. We aim to describe our single-center experience using the ‘Transmedics Organ Care System (OCS) ™ liver’ for extended normothermic liver preservation in CLLT.

*Methods: Medical records were queried for patients at our center that underwent CLLT from 2015-2020.

*Results: [Values shown are represented as mean (standard deviation, range)]: Four CLLTs were performed from 2015 to 2020 including 3 male and 1 female recipients, age 50 (±13.7, 31-61) years (Table 1). Indications for lung transplantation include: (1) cystic fibrosis (CF), (1) severe bronchiectasis, and (2) interstitial pulmonary fibrosis. Indications for liver transplantation include: (1) biliary cirrhosis secondary to CF, (1) cirrhosis secondary to autoimmune hepatitis, (1) alcoholic cirrhosis, and (1) cryptogenic cirrhosis. The lung was transplanted first for all patients. Recipient characteristics at transplant: Mean forced expiratory volume in 1 second (FEV1) was 51% (±22, 29-78) and Model for End-Stage Liver Disease was 12 (±3.7, 8-16). The livers were donated after brain death with donor age of 34 (±9.4, 25-46) years and cold ischemia time 566 (±38, 545-623) minutes. Ex-vivo pump time for the livers was 411 (±38, 364-456) minutes (Table 2). Mean hospital stay was 34 days (±18, 14-161). Over a median follow-up of 201 days, patient and graft survival remain at 100%, though 50% of liver grafts had biopsy-proven acute cellular rejection.

*Conclusions: CLLT is a viable treatment option for patients with severe two-organ failure. Normothermic extended liver preservation is a safe method to prolong perfusion time and preserve the liver during combined liver and lung transplantation.

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