Transplantation of liver, heart, and lungs for primary biliary cirrhosis and primary pulmonary hypertension.

Liver, heart, and lung replacement was performed in a woman with severe pulmonary hypertension, cardiorespiratory failure, and end-stage primary biliary cirrhosis. The main surgical considerations were the staging of the various parts of the operation in relation to cardiopulmonary bypass and performing the recipient procedures as expeditiously as possible to reduce the bypass time to a minimum. The patient was able to leave hospital on the 46th postoperative day on low doses of immunosuppressive agents, with excellent liver and cardiopulmonary function. This early satisfactory outcome shows the feasibility and potential of the procedure: such combined allografting may be a suitable treatment in carefully selected cases of advanced liver and lung disease from other causes.