Related Experiment Video
Updated: Mar 23, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Combined liver-thoracic transplantation: single-center experience with introduction of the 'Liver-first' principle
Laurens J Ceulemans1,2, Sébastien Strypstein1, Arne Neyrinck3
1Department of Microbiology and Immunology, Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Belgium.
Insights
Combined liver/thoracic transplantation (cLiThTx) offers excellent survival rates. This complex procedure for advanced liver and thoracic disease demonstrated 90% five-year patient survival with manageable complications and mild rejection episodes.
Area of Science:
- Transplant Surgery
- Thoracic Surgery
- Hepatobiliary Surgery
Background:
- Combined liver/thoracic transplantation (cLiThTx) is a complex procedure for patients with end-stage liver and heart/lung disease.
- Careful analysis of outcomes is crucial to avoid futile organ use.
Purpose of the Study:
- To analyze the surgical outcomes, complications, and survival rates of combined liver/thoracic transplantation.
- To evaluate the safety and efficacy of cLiThTx for advanced organ failure.
Main Methods:
- A single-center review of 14 consecutive cLiThTx cases (April 2000 - December 2015).
- Data collected included demographics, indications, surgical techniques, complications, rejection episodes, and five-year patient survival.
- Analysis focused on combined liver/heart (cLiHTx), combined liver/lung (cLiLuTx), and combined liver/heart/lung (cLiHLuTx) procedures.
Main Results:
- The study included 14 patients (3 cLiHTx, 10 cLiLuTx, 1 cLiHLuTx) with a median age of 42 years.
- Common indications included cystic fibrosis, hepatopulmonary fibrosis, and amyloidosis.
- Five-year patient survival was estimated at 90%, with mild and reversible rejection episodes. Complications included hepatic artery thrombosis and myocardial infarction, with successful retransplantation in one case.
Conclusions:
- Combined liver/thoracic transplantation is a safe procedure with excellent short- and long-term surgical and immunological outcomes.
- The study supports the viability of cLiThTx for carefully selected patients with advanced combined organ failure.
Abstract:
Combined liver/thoracic transplantation (cLiThTx) is a complex procedure for end-stage/advanced liver and heart(H)/lung(Lu) disease. To avoid futile use of multiple organs in single recipients, results should be scrutinously analyzed. Single-center cLiThTx (04/2000-12/2015) were reviewed for the following: demographics, indications, surgical technique, complications, rejection, and five-year patient survival. Results are reported as median (range). Fourteen consecutive patients underwent cLiThTx: 3 cLiHTx, 10 cLiLuTx, and 1 cLiHLuTx. Recipient age was 42 years (17-63 years). Most frequent indications were cystic fibrosis (n = 5), hepatopulmonary fibrosis (n = 2), amyloidosis (n = 2), and epithelioid hemangio-endothelioma (n = 2). Thoracic organs were transplanted first, except in three where LiTx preceded LuTx. In the latter, lungs were preserved by normothermic ex vivo lung perfusion. Stenting was performed for stenosis of bile duct (n = 4), hepatic artery (n = 2), and bronchus (n = 2). Abdominal interventions were required for bleeding (n = 3), evisceration (n = 1), and adhesiolysis (n = 1). One liver (cLiLuTx) was lost to hepatic artery thrombosis 3 months post-transplant and successfully retransplanted. One patient (cLiHTx) died 4 months post-transplant (myocardial infarction). Follow-up was 4 years (2 months-16 years). One liver and 5 pulmonary rejections occurred, all mild and reversible. Two patients developed bronchiolitis obliterans, one is clinically well 16 years post-transplant, and the other successfully retransplanted. Estimated 5-year patient survival is 90%. CLiThTx is safe with excellent short-/long-term surgical and immunological results.
