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CC BY 4.0 · Semin Liver Dis 2024; 44(03): 369-382
DOI: 10.1055/s-0044-1788674
Review Article

Combined Organ Transplantation in Patients with Advanced Liver Disease

Ingrid Wei Zhang
1   Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
2   Berlin Institute of Health (BIH) at Charité - Universitätsmedizin, Berlin, Germany
3   European Foundation for the Study of Chronic Liver Failure (EF CLIF) and Grifols Chair, Barcelona, Spain
,
Isabella Lurje
1   Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
,
Georg Lurje
4   Department of Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
,
Christoph Knosalla
5   Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
6   Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
7   DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
,
Felix Schoenrath
5   Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
6   Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
7   DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
,
Frank Tacke
1   Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
,
Cornelius Engelmann
1   Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
2   Berlin Institute of Health (BIH) at Charité - Universitätsmedizin, Berlin, Germany
› Author Affiliations Funding I.W.Z. is supported by the BIH Charité Clinician Scientist Program funded by the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health at Charité (BIH).
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Abstract

Transplantation of the liver in combination with other organs is an increasingly performed procedure. Over the years, continuous improvement in survival could be realized through careful patient selection and refined organ preservation techniques, in spite of the challenges posed by aging recipients and donors, as well as the increased use of steatotic liver grafts. Herein, we revisit the epidemiology, allocation policies in different transplant zones, indications, and outcomes with regard to simultaneous organ transplants involving the liver, that is combined heart–liver, liver–lung, liver–kidney, and multivisceral transplantation. We address challenges surrounding combined organ transplantation such as equity, utility, and logistics of dual organ implantation, but also advantages that come along with combined transplantation, thereby focusing on molecular mechanisms underlying immunoprotection provided by the liver to the other allografts. In addition, the current standing and knowledge of machine perfusion in combined organ transplantation, mostly based on center experience, will be reviewed. Notwithstanding all the technical advances, shortage of organs, and the lack of universal eligibility criteria for certain multi-organ combinations are hurdles that need to be tackled in the future.

Keywords

liver transplantation - combined transplantation - allocation - immunotolerance - machine perfusion


Publication History

Article published online:
25 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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