Transplantation

Question

Hello,
What are the risks of lung-liver transplantation for a CF patient? How is life expectancy increased by this? How much time? What are the risks of rejection?

Answer

Dear questioner,
The combined lung-liver transplant is a rare indication because liver cirrhosis is uncommon in cystic fibrosis (4-10%). In case there is a severe CF-related liver disease, one aims at doing a liver transplant before lung function declines as the risk of perioperative complications for a double transplant is high (1). It's nevertheless indicated when there is severe cirrhosis and when respiratory status is too precarious to consider only a liver transplant but also when there is a severe respiratory failure with a cirrhosis. It's a complex procedure performed by two teams (digestive and thoracic surgeons) in very few hospitals and therefore, there is very little data on survival rates. In one small series the overall survival of those receiving a combined liver and lung transplantation was 70% at one and three years (2).
In comparison, worldwide, the survival rate one year after lung transplantation is 80-90%, and 50% 5 years after lung transplantation. However, those data varies from country to country and center to center and is even different concerning the underlying illness that was the reason for lung failure. According to the registry of the International Society for Heart and Lung Transplantation (3), the median actuarial survival after lung transplantation was 6.7 years in all lung transplant recipients transplanted worldwide from 1994 to 2010; for patients, who had survived the first year, the median actuarial survival increased to 9.4 years. For CF lung transplant recipients these median actuarial survival times were 7.5 and 10.4 years, respectively, therefore, if CF is the underlying disease, survival rates are generally better.
It's difficult to say how long the life expectancy is increased because each case is unique and it depends on the life expectancy of the individual before transplantation. In general, a transplantation is only performed if the patient's life expectancy is arithmetically increased by transplantation, otherwise a transplant would not make any sense.
The risk of rejection is highly variable and often multifactorial. To give you some data, after 4 years post transplant about 50% of patients experience rejection, during the first year post transplant about 35% of patients have at least one episode of acute rejection. The main reasons are related to an unbalanced anti-rejection treatment or to infections.
Sincerely,
Dr. N. Dufeu and Dr. Daniela d'Alquen

1. 1 Corno V, Dezza MC, Lucianetti A, Codazzi D, Carrara B, Pinelli D et al. Combined double lungliver transplantation for cystic fibrosis without cardio-pulmonary by-pass. Am J Transplant 2007; 7(10):2433-2438.

2. Couetil JP, Houssin DP, Soubrane O, Chevalier PG, Dousset BE, Loulmet D et al. Combined lung and liver transplantation in patients with cystic fibrosis. A 4 1/2-year experience. J Thorac Cardiovasc Surg 1995; 110(5):1415-1422.

3. Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant 2012; 31(10):1073-1086.

07.10.2013