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Simultaneous Thoracic and Abdominal Transplantation: Can We Justify Two Organs for One Recipient?
Author(s) -
Wolf J. H.,
Sulewski M. E.,
Cassuto J. R.,
Levine M. H.,
Naji A.,
Olthoff K. M.,
Shaked A.,
Abt P. L.
Publication year - 2013
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12291
Subject(s) - medicine , transplantation , liver transplantation , organ transplantation , united network for organ sharing , lung transplantation , kidney transplantation , kidney , surgery , gastroenterology
Simultaneous thoracic and abdominal (STA) transplantation is controversial because two organs are allocated to a single individual. We studied wait‐list urgency, and whether transplantation led to successful outcomes. Candidates and recipients for heart–kidney (SHK), heart–liver (SHLi), lung–liver (SLuLi) and lung–kidney (SLuK) were identified through the United Network for Organ Sharing (UNOS) and outcomes were compared to single‐organ transplantation. Since 1987, there were 1801 STA candidates and 836 recipients. Wait‐list survival at 1‐ and 3 years for SHK (67.4%, 40.8%; N = 1420), SHLi (65.7%, 43.6%; N = 218) and SLuLi (65.7%, 41.0%; N = 122), was lower than controls (p < 0.001), whereas for SLuK (65.0%, 51.6%; N = 41) it was comparable (p = 0.34). All STA groups demonstrated similar 1‐ and 5 years posttransplant survival to thoracic controls. Compared to abdominal controls, 1‐ and 5 years posttransplant survival in SHK (85.3%, 74.0%; N = 684), SLuLi (75.5%, 59.0%; N = 42) and SLuK (66.7%, 55.6%; N = 18) was decreased (p < 0.01), but SHLi (85.9%, 74.3%; N = 92) was comparable (p = 0.81). In summary, STA candidates had greater risk of wait‐list mortality compared to single‐organ candidates. STA outcomes were similar to thoracic transplantation; however, outcomes were similar to abdominal transplantation for SHLi only. Although select patients benefit from STA, risk‐exposure variables for decreased survival should be identified, aiming to eliminate futile transplantation.