Combined lung-liver transplantation (CLLTx) is emerging as a viable option for end-stage lung and liver disease patients not expected to survive either transplant alone. We report our single-center outcomes after CLLTx. Under an IRB-approved protocol, we reviewed 6 consecutive CLLTx performed during 2009-2012. Transplant candidacy was determined by our center's criteria for each organ, with approval for dual listing after multidisciplinary review. Mean age was 46.2 ± 9.8 years old. Pulmonary indications included cystic fibrosis (CF) (n=2), idiopathic pulmonary fibrosis (IPF) (n=2), Α1-antitrypsin deficiency (AATD) (n=1) and pulmonary hypertension (PH) (n=1). Causes of cirrhosis were CF (n=2), viral hepatitis (n=2), AATD (n=1) and cryptogenic (CC) (n=1). Urgency was reflected by median lung allocation score (LAS) of 42.8 and median predicted forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC) of 24.7%/38.5%.

Median follow-up was 432.5 days. Patient survival at 30 days, 90 days and 1 year was 80% (5/6), 67% (4/6) and 60% (3/5) respectively, with those expired in acute respiratory failure requiring ventilator support preoperatively and having the highest recipient LAS. Deaths occurred from sepsis on postoperative day (POD) 7 and 58. Complications included bile duct leak (n=1) and ischemia (n=1) requiring surgical revision.

This small series reflects the largest United States single-center CLLTx reported, and suggests CLLTx as a viable option for patients with end-stage lung and liver disease, with those acutely ill and on high ventilator support less suitable for CLLTx.

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