Survival and Outcomes of Lung-Kidney and Lung-Liver Transplants Using a Large National Cohort

We used a national cohort to compare post-transplant outcomes of lung-kidney and lung-liver transplantation to isolated lung transplantation.

The United Network for Organ Sharing database was queried for all lung transplants performed from 1/1/2010-9/30/2024. Heart-lung and three-organ transplants were excluded. Patients undergoing isolated lung transplantation were compared with those undergoing simultaneous lung-kidney or lung-liver transplantation. Cox proportional hazards models assessed factors associated with one and three-year mortality. Temporal utilization trends were evaluated with linear regression.

Among 33,656 lung transplant recipients, 33,358 (99.1%) underwent isolated lung, 137 (0.4%) underwent lung-kidney, and 161 (0.5%) underwent lung-liver transplantation. One-year patient survival was lower for lung-kidney (79.7%) and lung-liver (82.6%) compared to lung (88.3%; log-rank p < 0.001) but not at three years (p = 0.101). Median survival was 6.3 (95% CI 6.2-6.4) years for lung, 6.2 (95% CI 4.3-10.0) years for lung-kidney, and 9.5 (95% CI 4.8-∞) years for lung-liver (log-rank p = 0.392). Following multivariable Cox risk adjustment, lung-liver was associated with increased one-year mortality (HR, 1.64; 95% CI, 1.11-2.41; p = 0.013) but not three-year mortality (HR, 1.23; 95% CI, 0.90-1.67; p = 0.187), while lung-kidney was not associated with mortality at one (p = 0.684) or three years (p = 0.162). On linear regression, the incidence of lung-kidney and lung-liver both increased over the study period at a faster rate than lung transplantation.

Although lung-kidney and lung-liver had lower one-year survival, three-year survival was not different compared to isolated lung transplantation after risk adjustment. Given inferior short-term outcomes, multiorgan recipients, particularly lung-kidney, require more sensitive patient selection to ensure equitable access to abdominal allografts. However, these findings cautiously support the viability and increased utilization of multiorgan lung transplantation in carefully selected patients.