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

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Purpose: Dual liver-lung transplantation (DLLT) is a rare procedure, with limited data characterizing patient demographics, risk factors, and post-transplant outcomes, particularly regarding hospital readmissions and emergency department (ED) presentations.This study aims to assess the rates of hospital readmission, ED presentations, and associated risk factors in DLLT recipients.Methods: A retrospective analysis was conducted on patients at our center who underwent DLLT between 2013 and 2024.Demographics, transplant indications, length of stay, acute rejection, causes of readmission, and ED presentations were analyzed.Readmission rates were categorized as occurring within 0-3 months and between 3 months and 1 year post-transplant.Mortality outcomes were also assessed.Results: Ten patients (5 male, 5 female) with a mean age of 53.7 years underwent DLLT.Liver disease etiologies were ethanol-related cirrhosis (n=2), hepatitis C (n=1), cryptogenic cirrhosis (n=1), autoimmune hepatitis (n=1), cystic fi brosis (n=1), and other unspecifi ed causes (n=4).Lung transplant indications included idiopathic pulmonary fi brosis (n=5), pulmonary hypertension (n=2), interstitial lung disease (n=2), and cystic fi brosis (n=1).All patients (100%) were readmitted within 3 months, and 40% experienced additional readmissions within the fi rst year.The most common causes of early readmissions (0-3 months) included infections (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%).ED presentations within 1 year occurred in 50% of patients, with leading causes including melena (n=2), tachycardia (n=1), fever (n=1), and gastrostomy tube dysfunction (n=1).Initial length of stay, lung transplant etiology, liver disease etiology, and age at transplantation were not associated with readmission or ED presentation rates (p>0.05).Two patients (20%) died within 10 years post-transplant, one at 4 years and one at 8 years.Readmission within 1 year was not signifi cantly associated with mortality at 5 or 10 years.Conclusions: DLLT recipients experience high rates of early readmission, with infections being the leading cause.ED presentations are common, with gastrointestinal and infectious concerns predominating.No signifi cant associations were found between transplant etiology, initial hospital stay, or age at transplantation and readmission or ED presentation rates.Long-term mortality was not associated with early readmission.These fi ndings underscore the need for enhanced post-transplant surveillance and targeted interventions to mitigate early complications.

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