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Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation.

Publication ,  Journal Article
Freischlag, K; Schroder, PM; Ezekian, B; Cox, ML; Mulvihill, MS; Hartwig, MG; Knechtle, SJ
Published in: J Surg Res
November 2018

BACKGROUND: Liver-lung transplantation (LLT) is a rare procedure performed for patients with end-stage liver and lung disease. The lung allocation score (LAS), introduced in 2005, guides lung allocation including those receiving LLT. However, the impact of the LAS on outcomes in LLT is currently unknown. MATERIALS AND METHODS: The OPTN/United Network for Organ Sharing STAR file was queried for LLT candidates and recipients from 1988 to 2016. Demographic characteristics before (historic) and after (modern) the LAS were compared. Survival was analyzed with the Kaplan-Meier method and log-rank test. RESULTS: In total, 167 candidates were listed for LLT, and 62 underwent LLT. The historic cohort had a higher FEV1% (48.22% versus 29.82%, P = 0.014), higher creatinine (1.22 versus 0.72, P < 0.001), and a higher percentage with pulmonary hypertension as the indication for transplantation (40% versus 0%, P = 0.003) compared with the modern cohort. LLT candidates in the historic cohort had a lower rate of transplant per 100 candidates (10.87 versus 33.33, P < 0.0001) and worse waitlist survival (1 y: 69.6% versus 80.9%, 3 y: 39.1% versus 66.8%, P = 0.004). Post-transplant survival was significantly lower in the historic cohort (1 y: 50.0% versus 82.7%, 5 y: 40.0% versus 69.0%, 10 y: 20.0% versus 55.5%, P = 0.0099). CONCLUSIONS: Most analyses of LLT have included patients before and after the introduction of the LAS. Our study shows that LLT candidates and recipients before the modern allocation system had distinct baseline characteristics and worse overall survival. Although many factors contributed to recent improved outcomes, these cohorts are significantly different and should be treated as such in future studies.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

November 2018

Volume

231

Start / End Page

395 / 402

Location

United States

Related Subject Headings

  • Young Adult
  • Waiting Lists
  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Selection
  • Middle Aged
 

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Freischlag, K., Schroder, P. M., Ezekian, B., Cox, M. L., Mulvihill, M. S., Hartwig, M. G., & Knechtle, S. J. (2018). Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation. J Surg Res, 231, 395–402. https://doi.org/10.1016/j.jss.2018.06.007
Freischlag, Kyle, Paul M. Schroder, Brian Ezekian, Morgan L. Cox, Michael S. Mulvihill, Matthew G. Hartwig, and Stuart J. Knechtle. “Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation.J Surg Res 231 (November 2018): 395–402. https://doi.org/10.1016/j.jss.2018.06.007.
Freischlag K, Schroder PM, Ezekian B, Cox ML, Mulvihill MS, Hartwig MG, et al. Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation. J Surg Res. 2018 Nov;231:395–402.
Freischlag, Kyle, et al. “Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation.J Surg Res, vol. 231, Nov. 2018, pp. 395–402. Pubmed, doi:10.1016/j.jss.2018.06.007.
Freischlag K, Schroder PM, Ezekian B, Cox ML, Mulvihill MS, Hartwig MG, Knechtle SJ. Improved survival in simultaneous lung-liver recipients and candidates in the modern era of lung allocation. J Surg Res. 2018 Nov;231:395–402.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

November 2018

Volume

231

Start / End Page

395 / 402

Location

United States

Related Subject Headings

  • Young Adult
  • Waiting Lists
  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Patient Selection
  • Middle Aged