The liver-first approach for combined lung and liver transplantation

Combined lung and liver transplantation (Lu-LTx) is an established therapy for patients with cystic fibrosis. The initial sequence has primarily been lung first. We changed the sequence to 'liver first' in 2006. The aim of this study is to present outcomes of this procedure. The records of combined lung and liver transplant patients treated at our institution between April 1999 and November 2016 were reviewed retrospectively. A total of 27 patients received a combined Lu-LTx at our institute. Seventeen patients underwent Lu-LTx beginning with the lung transplantation. In this group, 5 patients had cystic fibrosis (lung first). The other 10 patients received the liver transplant first (liver first). All patients in this group had cystic fibrosis as underlying disease. The lung-first group showed a trend towards longer stays in the intensive care unit (ICU) and in the hospital [median 17 days in the ICU, interquartile range (IQR) 3-47 and 55 in-hospital days, IQR 29-108] than the liver-first group (median 6 days in the ICU, IQR 4-19 and 33 in-hospital days, IQR 26-63). The 90-day, 1- and 5-year survival rates were 80%, 60% and 20% in the lung-first group vs 90%, 79% and 79% in the liver-first group. We present the largest series of patients following combined Lu-LTx according to the liver-first approach. The liver-first sequence results in favourable outcomes in our cohort of combined lung and liver transplants.