Korean J Transplant.  2022 Nov;36(Supple 1):S84. 10.4285/ATW2022.F-2009.

Analysis of status and waiting period of simultaneous transplant (heart-lung, heart-liver) recipients

• Kim IO
• Hong JJ
• Hwang S
• Kim JJ
• Jung SH

• KMID: 2535600
• DOI: http://doi.org/10.4285/ATW2022.F-2009

Abstract

Background
Simultaneous heart and lung transplantation was performed for the first time on July 24, 2010 at Asan Medical Center. Simultaneous heart and liver transplantation was performed on November 17, 2012, and simultaneous heart, lung and liver transplantation was performed on December 7, 2013, the first in Korea. The criteria for selecting deceased donor organs differ according to the characteristics of each organ, in the case of liver, heart and lung, emergency status is the first consideration. Because there is a shortage of deceased donors, selection of multi-organ transplant recipients requires a complex and careful decision process from the donor's management.
Methods
In this study, the degree of emergency status and waiting period of heart-lung and heart-liver transplant recipients performed at our hospital were retrospectively investigated through KONOS computer network data and medical records.
Results
In our hospital, a total of 16 heart-lung transplants were performed until November 21, 2021. The gender of transplant recipients was 10 males and six females. Blood types were five type A, four type AB, five type B, and two type O patients. The average age at the time of transplantation was 35 years old (1–64 years) for males and 30 years old (5–49 years) for females. At the time of transplantation, the final emergency status (Status, S) was S0 (11 patients), S1 (three patients), S3 (two patients) for heart and S0 (10 patients), S1 (three patients), S2 (three patients) for lung. The average of the total waiting period was 161 days, and the average of the waiting days after the emergency level was raised was 32 days. At the time of transplantation, the average waiting period for each emergency status (Status, S) was 31.9 (2–114) days for heart S0, 719 (57–1,926) days for S1, and 33 (4–87) days for S2. After the emergency level was raised, the waiting period was 15 (1–95) days for S0, 194 (17–3641) days for S1, and 165 days for S3. Lung were S0 31.9 (2–114) days, S1 719 (57–1,926) days, and S2 33 (4–87) days. After the emergency level was raised, the waiting period was S0 21.9 (2–98) days for S0, 67 (17–165) days for S1, and 30 (1–87) days for S2. A total of six cases of heart and liver transplantation were performed until November 26, 2020. The gender of transplant recipients was four males and two females. Blood types were four type A, one type AB and one type B patients. The average age at the time of transplan-tation was 43 years old (35–46 years) for males and 58 years old (57–59 years) for females. The final emergency status (Status, S) at the time of transplantation was S0 (five patients) and S1 (one patient) for heart, and for liver in 2012 (2A) and after 2016, the average model for end-stage liver disease (MELD) was 39 (37–40). Average waiting period was S0 (13 days), S1 (4 days) for heart, 2012 (2 days) for liver, and after MELD system in 2016 (7 days). Recipients with a long waiting period (14 days, 29 days) died (42 and 76 days after transplantation), and four patients with a short waiting period (2–10 days) are still alive.
Conclusions
Due to the shortage of deceased donors, the use of extended category donors is expanding. It is considered that it is necessary to continue discussing the efficient multi-organ distribution standard that can increase the survival rate of patients with high-severity emergency organ transplantation.