Outcomes and Risk Factors for Post-Operative Rejection and Transaminitis Following Dual Liver-Lung Transplantation: A Retrospective Cohort Study

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Dual liver-lung transplantation (DLLT) is a rare and complex procedure, with limited data on post-operative rejection and liver function abnormalities. Understanding risk factors for acute cellular rejection and transaminitis is critical for optimizing immunosuppressive management. This study evaluates post-transplant outcomes in DLLT recipients and explores associations with recipient demographics, transplant indication, and underlying liver lung disease etiology. Methods: A retrospective analysis was conducted on patients at our center who underwent DLLT between 2013 and 2024. Data collected included demographics, transplant indications, length of stay, incidence of acute rejection, and subsequent infections. Post-operative liver function tests (LFTs) beyond one month post-transplant were analyzed, and their relationship with age at transplant, liver disease etiology, and lung disease etiology was assessed. Results: A total of 10 patients (5 males, 5 females, mean age 53.7 years) underwent DLLT between 2013 and 2024. Liver disease etiologies were ethanol-related cirrhosis (n=2), hepatitis C (n=1), cryptogenic cirrhosis (n=1), autoimmune hepatitis (n=1), cystic fibrosis (n=1), and other unspecified causes (n=4). Lung transplant indications included idiopathic pulmonary fibrosis (n=5), pulmonary hypertension (n=2), other forms of interstitial lung disease (n=2), and cystic fibrosis (n=1).Post-operatively, 4 of 10 patients developed transaminitis beyond one month post-transplant, with liver biopsy confirming acute cellular rejection. Three patients received IV solumedrol, while one was managed with an oral steroid taper. Transaminitis resolved in all four cases after steroid treatment. Within three months, two patients treated with IV solumedrol developed infections from Candida and Aspergillus, though none developed CMV viremia. Two deaths occurred in the cohort. One patient passed away four years after transplant due to multifocal pneumonia, while the second patient passed away nine years post-transplant due to septic shock secondary to pneumonia in the setting of a new diagnosis of angiosarcoma. Neither patient had experienced rejection. Rejection and transaminitis were not significantly associated with age at transplant, liver disease etiology, or lung disease etiology. Conclusions: This study provides one of the first detailed assessments of rejection and liver function abnormalities following DLLT. While transaminitis and acute cellular rejection occurred in 40% of patients, no clear predisposing factors were identified. IV solumedrol use for rejection was associated with increased infection risk, emphasizing the need for careful immunosuppressive management in this population. Further research with larger cohorts is essential to improve risk stratification and post-transplant care in DLLT recipients. CITATION INFORMATION: Saleem A., Obri M., Ilyas O., Alomari A., Faisal M., Abusuliman M., Chaudhary A., Rehman S., Franco-Palacios D., Nagai S., Venkat D., Jafri S. Outcomes and Risk Factors for Post-Operative Rejection and Transaminitis Following Dual Liver-Lung Transplantation: A Retrospective Cohort Study AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Saleem: None.

Volume

25

Issue

8

First Page

S468

Last Page

S469

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