The state of combined thoracoabdominal triple-organ transplantation in the United States
Background: As triple-organ transplantation (TOT) has become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT. Methods: This retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001289 |
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| author | Emily G. Dunbar, BS Ye In Christopher Kwon, BA Matthew Ambrosio, MS Inna F. Tchoukina, MD Keyur B. Shah, MD David A. Bruno, MD Walker A. Julliard, MD Josue Chery, MD Vigneshwar Kasirajan, MD Zubair A. Hashmi, MD |
| author_facet | Emily G. Dunbar, BS Ye In Christopher Kwon, BA Matthew Ambrosio, MS Inna F. Tchoukina, MD Keyur B. Shah, MD David A. Bruno, MD Walker A. Julliard, MD Josue Chery, MD Vigneshwar Kasirajan, MD Zubair A. Hashmi, MD |
| author_sort | Emily G. Dunbar, BS |
| collection | DOAJ |
| description | Background: As triple-organ transplantation (TOT) has become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT. Methods: This retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-kidney-liver (HKL), and heart-kidney-pancreas (HKP) recipients from the United Network for Organ Sharing registry between 1989 and 2023. Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Recipient survival up to 10 years was analyzed using the Kaplan-Meier method. Results: During the study period, 81 TOTs were performed (13 HLLs, 13 HLKs, 46 HKLs, and 9 HKPs). There were no statistically significant differences in long-term survival between TOTs (p = 0.13). However, HLL and HLK recipients had significantly worse (p < 0.0001) and improved (p < 0.0001) survival, respectively, when compared to heart-lung, isolated heart, and lung transplant recipients. HLK was associated with improved survival (hazard ratios [HR]: 0.22, p = 0.033). We found no differences in survival among HKL (p = 0.24) and HKP (p = 0.19) recipients compared to their dual- and single-organ counterparts. TOTs after 2007 (HR: 0.29, p = 0.003) were associated with improved survival, whereas increased recipient age (HR: 1.06, p = 0.037), estimated glomerular filtration rate (HR: 1.02, p = 0.005), and donor age (HR:1.05, p = 0.031) were associated with higher mortality. Conclusions: The prevalence of TOTs has dramatically increased over the past decade. While overall survival between TOTs appears similar, adding a liver to a heart-lung transplant may be associated with a poorer prognosis compared to adding a kidney. A careful, multidisciplinary approach to patient selection and management remains paramount in optimizing outcomes for high-risk patients undergoing TOTs. |
| format | Article |
| id | doaj-art-5cf865813a5644338482b917d48de691 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-5cf865813a5644338482b917d48de6912025-02-09T05:01:55ZengElsevierJHLT Open2950-13342025-02-017100179The state of combined thoracoabdominal triple-organ transplantation in the United StatesEmily G. Dunbar, BS0Ye In Christopher Kwon, BA1Matthew Ambrosio, MS2Inna F. Tchoukina, MD3Keyur B. Shah, MD4David A. Bruno, MD5Walker A. Julliard, MD6Josue Chery, MD7Vigneshwar Kasirajan, MD8Zubair A. Hashmi, MD9Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Corresponding author: Ye In Christopher Kwon, BA, School of Medicine, Virginia Commonwealth University, 1201 E. Marshall Street, Richmond, VA 23298.Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VirginiaDivision of Abdominal Transplant Surgery, Department of Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VirginiaDivision of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VirginiaBackground: As triple-organ transplantation (TOT) has become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT. Methods: This retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-kidney-liver (HKL), and heart-kidney-pancreas (HKP) recipients from the United Network for Organ Sharing registry between 1989 and 2023. Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Recipient survival up to 10 years was analyzed using the Kaplan-Meier method. Results: During the study period, 81 TOTs were performed (13 HLLs, 13 HLKs, 46 HKLs, and 9 HKPs). There were no statistically significant differences in long-term survival between TOTs (p = 0.13). However, HLL and HLK recipients had significantly worse (p < 0.0001) and improved (p < 0.0001) survival, respectively, when compared to heart-lung, isolated heart, and lung transplant recipients. HLK was associated with improved survival (hazard ratios [HR]: 0.22, p = 0.033). We found no differences in survival among HKL (p = 0.24) and HKP (p = 0.19) recipients compared to their dual- and single-organ counterparts. TOTs after 2007 (HR: 0.29, p = 0.003) were associated with improved survival, whereas increased recipient age (HR: 1.06, p = 0.037), estimated glomerular filtration rate (HR: 1.02, p = 0.005), and donor age (HR:1.05, p = 0.031) were associated with higher mortality. Conclusions: The prevalence of TOTs has dramatically increased over the past decade. While overall survival between TOTs appears similar, adding a liver to a heart-lung transplant may be associated with a poorer prognosis compared to adding a kidney. A careful, multidisciplinary approach to patient selection and management remains paramount in optimizing outcomes for high-risk patients undergoing TOTs.http://www.sciencedirect.com/science/article/pii/S2950133424001289heart-kidney-liver transplantheart-lung-kidney transplantheart-kidney-pancreas transplantheart-liver-lung transplanttriple-organ transplant |
| spellingShingle | Emily G. Dunbar, BS Ye In Christopher Kwon, BA Matthew Ambrosio, MS Inna F. Tchoukina, MD Keyur B. Shah, MD David A. Bruno, MD Walker A. Julliard, MD Josue Chery, MD Vigneshwar Kasirajan, MD Zubair A. Hashmi, MD The state of combined thoracoabdominal triple-organ transplantation in the United States JHLT Open heart-kidney-liver transplant heart-lung-kidney transplant heart-kidney-pancreas transplant heart-liver-lung transplant triple-organ transplant |
| title | The state of combined thoracoabdominal triple-organ transplantation in the United States |
| title_full | The state of combined thoracoabdominal triple-organ transplantation in the United States |
| title_fullStr | The state of combined thoracoabdominal triple-organ transplantation in the United States |
| title_full_unstemmed | The state of combined thoracoabdominal triple-organ transplantation in the United States |
| title_short | The state of combined thoracoabdominal triple-organ transplantation in the United States |
| title_sort | state of combined thoracoabdominal triple organ transplantation in the united states |
| topic | heart-kidney-liver transplant heart-lung-kidney transplant heart-kidney-pancreas transplant heart-liver-lung transplant triple-organ transplant |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001289 |
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