{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:45:46Z","timestamp":1775720746091,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":97,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dual liver\u2013lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end\u2010stage hepatic and pulmonary disease. The combined operative complexity and dual\u2010organ immunosuppressive burden may predispose recipients to early morbidity and graft\u2010threatening complications [1\u20134].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of adult DLLT recipients at a single tertiary center (2013\u20132024). Variables included demographics, transplant indications, ischemia times, readmissions (0\u20133\u2009months; 3\u201312\u2009months), infections (timing\/etiology\/site), biopsy\u2010proven rejection, malignancy, and survival. ACR was biopsy\u2010confirmed in cases of unexplained transaminitis beyond 30\u2009days posttransplant. Analyses were descriptive, consistent with STROBE recommendations for small cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten patients (mean age 53.7\u2009years; 50% female) underwent DLLT. Liver etiologies included alcohol\u2010related cirrhosis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), HCV (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), cryptogenic (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), autoimmune (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), cystic fibrosis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and unspecified (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094). Lung indications were IPF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), pulmonary hypertension (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), ILD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), and CF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091). All patients were readmitted within 90\u2009days, most commonly for infection (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%). Biopsy\u2010proven ACR occurred in 4\/10 patients (40%) after the first month, uniformly presenting with hepatocellular transaminemia; 3\/4 received pulse\u2010dose IV corticosteroids and 2\/3 subsequently developed invasive fungal disease (Aspergillus and\n                      <jats:italic>Candida<\/jats:italic>\n                      ). Overall, 9\/10 experienced infection within 6\u2009months, predominantly pulmonary (fungal\/bacterial pneumonias). Three patients developed malignancy (basal cell carcinoma, prostate carcinoma, and angiosarcoma [fatal]). Survival was 90% at 1\u2009year, 70% at 3\u2009years, and 60% at 5\u2009years; no 10\u2009year survivors were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DLLT is associated with early readmission and a high infectious burden, particularly invasive fungal disease after steroid\u2010treated ACR. Despite significant early morbidity, short\u2010term survival is favorable. Multicenter studies are needed to refine candidate selection, balance rejection prophylaxis with antifungal strategies, and standardize long\u2010term oncologic and dermatologic surveillance in DLLT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/joot\/9414873","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T06:52:14Z","timestamp":1775717534000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Outcomes and Risk Profiles in Dual Liver\u2013Lung Transplantation: A Single\u2010Center Retrospective Analysis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8555-8721","authenticated-orcid":false,"given":"Abdulmalik","family":"Saleem","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-7125","authenticated-orcid":false,"given":"Omar","family":"Ilyas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Obri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Alomari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4785-7922","authenticated-orcid":false,"given":"Muhammad Saad","family":"Faisal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haya","family":"Omeish","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2986-3988","authenticated-orcid":false,"given":"Ammad","family":"Chaudhary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yara","family":"Dababneh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1540-5681","authenticated-orcid":false,"given":"Uthman","family":"Shukairy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Nagai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0325-6744","authenticated-orcid":false,"given":"Domingo","family":"Franco-Palacios","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Venkat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2817-6223","authenticated-orcid":false,"given":"Adarsh","family":"Varma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-7408","authenticated-orcid":false,"given":"Syed-Mohammed","family":"Jafri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.01945.x"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001482"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.02.039"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-5223(95)70064-1"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-021-00549-8"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2021-11"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00430-016-0485-7"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2200923"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-018-3183-0"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181636f3f"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23770"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13545"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2021-26"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.07.035"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abo2628"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201910-1915OC"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2011.02.008"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2004.11.049"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezab164"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12781"},{"key":"e_1_2_11_21_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i25.3123"},{"key":"e_1_2_11_22_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01908"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01615"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02667"},{"key":"e_1_2_11_25_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01044"},{"key":"e_1_2_11_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13870"},{"key":"e_1_2_11_27_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.02.062"},{"key":"e_1_2_11_28_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.10.059"},{"key":"e_1_2_11_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2021.02.004"},{"key":"e_1_2_11_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002529"},{"key":"e_1_2_11_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000165717.23652.09"}],"container-title":["Journal 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