Trends and recipient outcomes in multiorgan transplantation in the United States 2013-2023

Multiorgan transplantation (MOT) in the United States is increasing, but data on the epidemiology and posttransplant outcomes are lacking. Using the Scientific Registry of Transplant Recipients database, we examined annual transplant volume, mortality, and graft failure in adult recipients who received a liver, heart, lung, and/or kidney transplant between 2013 and 2023. A total of 380 938 transplant recipients were included in the present study. MOT volume for the liver, heart, lung, and kidney increased between 2013 and 2023. Relative to liver transplantation alone, liver-kidney (adjusted hazard ratio [aHR], 1.22; 95% confidence interval [CI], 1.16-1.29), liver-heart (aHR, 1.82; 95% CI, 1.38-2.40), and liver-lung transplantation (aHR, 2.63; 95% CI, 2.01-3.44) were associated with increased mortality. Relative to heart transplantation alone, heart-liver (aHR, 1.49; 95% CI, 1.17-1.90) and heart-lung (aHR, 2.52; 95% CI, 2.15-2.96) were associated with increased mortality. Relative to lung transplantation alone, lung-heart transplantation (aHR, 1.25; 95% CI, 1.05-1.49) was associated with increased mortality. Compared with kidney transplantation alone, the combinations of kidney-liver (aHR, 1.94; 95% CI, 1.77-2.12), kidney-heart (aHR, 2.35; 95% CI, 1.96-2.83), and kidney-lung (aHR, 6.03; 95% CI, 3.39-10.70) transplantation were associated with increased mortality. Many combinations of MOT are associated with increased mortality and graft failure rates. As MOT increases, a sensible allocation policy is needed for patients with multiorgan failure to ensure equitable distribution of these scarce resources.