BACKGROUND.: Combined lung and liver transplantation (Lu-LTx) is a therapeutic option for selected patients with coexisting lung and liver disease. For several reasons, Lu-LTx is performed in few centers and information about the technical issues, posttransplant management and long-term outcomes associated with this procedure is limited. METHODS.: We analyzed data from 13 consecutive patients who underwent combined Lu-LTx at Hannover Medical School (Hannover, Germany) between April 1999 and December 2003. The main indications were cystic fibrosis, alpha1-proteinase inhibitor deficiency and portopulmonary hypertension. All patients had advanced cirrhosis and severe pulmonary disease manifestation. RESULTS.: Ten patients received a sequential double Lu-LTx, one patient received a single Lu-LTx, one received a double lung and split liver transplantation, and one received an en-bloc heart-lung and liver translantation. Immunosuppression was based on cyclosporine in a triple/quadruple regimen. Postoperative surgical complications occurred in eight patients. There were two perioperative deaths; two patients died during the first year on day 67 and 354, respectively, and one patient died at month 53. The overall patient survival rates at 1, 3, and 5 years were 69%, 62%, and 49%, respectively. CONCLUSION.: Combined Lu-LTx is a therapeutic option for highly selected patients with end-stage lung and liver disease with acceptable long-term outcome.

Grannas G, Neipp M, Hoeper MM, Gottlieb J, Lück R, Becker T, Simon A, Strassburg CP, Manns MP, Welte T, Haverich A, Klempnauer J, Nashan B, Strueber M.

1 Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. 2 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 3 Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. 4 Department of Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany. 5 Department of Hepatobiliary and Transplant Surgery, Medical University Hamburg-Eppendorf, Hamburg, Germany