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Survival Following Simultaneous Liver-Lung versus Liver Alone Transplantation: Results of the US National Experience

J. Purvis, M. C. Mcleod, B. J. Orandi, D. E. Eckhoff, J. E. Locke, R. M. Cannon

Surgery, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2020 American Transplant Congress

Abstract number: B-297

Keywords: N/A, Resource utilization

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session B: Lung: All Topics

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

Related Abstracts
  • A Propensity Matched Survival Analysis: Do Simultaneous Liver-Lung Transplant Recipients Need a Liver?
  • Implementation of the Lung Allocation Score is Associated with Decreased Mortality in Combined Liver-Lung Allograft Recipients

*Purpose: Although simultaneous thoracic-abdominal transplants are undoubtedly complex, there is little data to compare the post-transplant survival between lung-liver transplant (LLT) and liver alone recipients. This study was undertaken to determine if survival after LLT is inferior to liver-alone transplant.

*Methods: United Network for Organ Sharing data for patients who underwent LLT from 2002-2017 was analyzed. LLT recipients were matched 4:1 to liver-alone recipients (n=324) by propensity score matching on donor and recipient variables. Covariate balance after matching was assessed by standardized difference, with standardized difference >0.1 in absolute value indicating significant residual difference between groups. The primary endpoint of patient survival was analyzed in the matched cohort, controlling for covariates with residual imbalance.

*Results: There were 94 patients who underwent LLT, of whom 11 were excluded from comparison with liver-alone recipients due to also receiving either simultaneous heart or pancreas grafts. The most common indication for LLT was cystic fibrosis (n=47). The LLT recipients were majority male (56%), and Caucasian (93%) at a mean age of 34.7 (16.6) years and a mean calculated model for end-stage liver disease (MELD) score at transplant of 11.2 (5.4). After matching, the mean MELD score at transplant was 11.4(5.6) for the LLT group vs. 12.9(11.3) for the liver-alone recipients. After matching, the liver-only recipients more commonly received organs from regional (8.3% vs 6.2%) and national (7.4% vs 4.9%) donors, while the LLT group had significantly higher rates of pretransplant dialysis (1.2% vs 0.6%), Hispanic recipients (2.5% vs 1.5%), female donors (42% vs 37%), and donors whose cause of death was a CNS tumor (1.2% vs 0.3%). Post-transplant survival was significantly worse for LLT vs. liver-alone recipients in the matched cohort(figure). The inferior survival seen with LLT persisted after adjusting for covariates with residual imbalance after matching (HR 1.92, 95% CI 1.26-2.92; p=0.003).

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Figure: Patient survival in a propensity matched cohort of liver-lung vs. liver alone transplant recipients.

*Conclusions: LLT has significantly worse survival compared to liver-alone transplant. In an era of increasing organ shortage, such combined transplants should be limited to extremely highly selected cases.

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To cite this abstract in AMA style:

Purvis J, Mcleod MC, Orandi BJ, Eckhoff DE, Locke JE, Cannon RM. Survival Following Simultaneous Liver-Lung versus Liver Alone Transplantation: Results of the US National Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/survival-following-simultaneous-liver-lung-versus-liver-alone-transplantation-results-of-the-us-national-experience/. Accessed March 4, 2021.

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