Related Experiment Videos
Heart-lung-liver transplantation
C M Dennis1, K D McNeil, J Dunning
1Transplant Unit Papworth Hospital, Cambridge, United Kingdom.
Insights
Combined heart-lung-liver transplantation is a feasible procedure for patients with advanced lung and liver disease. This approach offers satisfactory long-term outcomes for selected individuals, improving survival and quality of life.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
- Transplantation Surgery
Background:
- Cystic fibrosis and primary biliary cirrhosis can lead to advanced pulmonary and hepatic disease.
- Portal hypertension is a significant complication in cystic fibrosis patients with hepatic fibrosis or cirrhosis.
- Plexogenic pulmonary hypertension necessitates advanced treatment strategies.
Purpose of the Study:
- To evaluate the feasibility and outcomes of combined heart-lung-liver transplantation.
- To assess the long-term survival and functional status of patients undergoing this complex procedure.
- To determine the efficacy of concurrent transplantation in managing combined cardiopulmonary and hepatic failure.
Main Methods:
- Retrospective case series of four patients undergoing combined heart-lung-liver transplantation.
- Inclusion criteria: advanced cystic fibrosis or primary biliary cirrhosis with pulmonary hypertension.
- Assessment of post-transplant survival, pulmonary function, hepatic function, and New York Heart Association class.
Main Results:
- Three of four patients survived long-term (20, 50, 100 months) post-transplantation.
- Survivors demonstrated well-preserved pulmonary function (FEV1 49-110% predicted) and normal hepatic function.
- One patient with cystic fibrosis died early (day 16) due to pneumonia.
Conclusions:
- Combined heart-lung-liver transplantation is a viable option for carefully selected patients with end-stage cardiopulmonary and hepatic disease.
- The procedure can lead to satisfactory long-term survival and functional recovery.
- This complex surgical approach addresses multiple organ system failure effectively.
Abstract:
We report three patients with cystic fibrosis and one patient with primary biliary cirrhosis and plexogenic pulmonary hypertension who have undergone heart-lung-liver transplantation as a combined procedure. Liver transplantation was necessary in the three patients with cystic fibrosis because of portal hypertension secondary to either hepatic fibrosis or established cirrhosis in addition to their advanced lung disease. Three of the four patients were alive at 20, 50, and 100 months after transplantation (one patient with cystic fibrosis died on day 16 of pneumonia) with well-preserved pulmonary function (forced expiratory volume in 1 second 110%, 49%, and 100% predicted, respectively), normal hepatic function and New York Heart Association class 1 performance status. Heart-lung and concurrent liver transplantation is a feasible and successful procedure with a satisfactory long-term outcome in selected patients with advanced pulmonary and hepatic disease.