Background Dual liver–lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end‐stage hepatic and pulmonary disease. The combined operative complexity and dual‐organ immunosuppressive burden may predispose recipients to early morbidity and graft‐threatening complications 1–4. Objective To characterize early and late postoperative events (including acute cellular rejection (ACR), infectious complications, malignancy, and hospital readmissions) after DLLT and to describe associated clinical patterns. Methods We performed a retrospective cohort study of adult DLLT recipients at a single tertiary center (2013–2024). Variables included demographics, transplant indications, ischemia times, readmissions (0–3 months; 3–12 months), infections (timing/etiology/site), biopsy‐proven rejection, malignancy, and survival. ACR was biopsy‐confirmed in cases of unexplained transaminitis beyond 30 days posttransplant. Analyses were descriptive, consistent with STROBE recommendations for small cohorts. Results Ten patients (mean age 53.7 years; 50% female) underwent DLLT. Liver etiologies included alcohol‐related cirrhosis ( n = 2), HCV ( n = 1), cryptogenic ( n = 1), autoimmune ( n = 1), cystic fibrosis ( n = 1), and unspecified ( n = 4). Lung indications were IPF ( n = 5), pulmonary hypertension ( n = 2), ILD ( n = 2), and CF ( n = 1). All patients were readmitted within 90 days, most commonly for infection (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%). Biopsy‐proven ACR occurred in 4/10 patients (40%) after the first month, uniformly presenting with hepatocellular transaminemia; 3/4 received pulse‐dose IV corticosteroids and 2/3 subsequently developed invasive fungal disease (Aspergillus and Candida ). Overall, 9/10 experienced infection within 6 months, predominantly pulmonary (fungal/bacterial pneumonias). Three patients developed malignancy (basal cell carcinoma, prostate carcinoma, and angiosarcoma fatal). Survival was 90% at 1 year, 70% at 3 years, and 60% at 5 years; no 10 year survivors were observed. Conclusions DLLT is associated with early readmission and a high infectious burden, particularly invasive fungal disease after steroid‐treated ACR. Despite significant early morbidity, short‐term survival is favorable. Multicenter studies are needed to refine candidate selection, balance rejection prophylaxis with antifungal strategies, and standardize long‐term oncologic and dermatologic surveillance in DLLT.
Saleem et al. (2026) studied this question.