VitalMatch · Data summary

Dual-organ lung recipients don’t outlive single-organ recipients. It only looks that way.

Across the whole registry, lung-liver recipients show better five-year survival than lung-only recipients. Match the eras and the advantage disappears — leaving a real, and different, finding underneath.

Source: OPTN/UNOS STAR, Dec 2025 release · 60,311 lung transplants; simultaneous dual-organ identified by same transplant date and same donor across organ files.

62% → 61%lung-liver 5-yr survival

All-era lung-liver survival of 62.2% beats lung-only’s 55.9%. Restricted to 2015+, the two are 61.0% vs 59.7% — a dead heat. The gap was era, not procedure.

01 · The artifact

Why the naive comparison is wrong

Dual-organ transplantation is concentrated in recent years, and lung survival improved substantially over the same period. Comparing groups across the full registry compares eras as much as procedures.

Five-year survival by group (%)

all eras2015 onward

Heart-lung is the clearest case. Its all-era five-year survival of 48.0% badly misrepresents current practice: since 2015 it is 61.2%, with 30-day survival up from 85.2% to 92.3%. Quoting the all-era number understates the modern operation by more than thirteen points.

02 · The real finding

The cost is early, not late

Era-matched, every dual-organ group converges on the lung-only five-year figure. The separation is in the first year.

One-year survival, transplants since 2015 (%)

Lung-liver one-year survival is 80.7% [73–88] against 88.9% for lung-only — roughly eight percentage points, with intervals that barely meet. Recipients who clear the first year then track the single-organ population closely.

03 · Volume

A rare operation becoming less rare

Simultaneous lung-liver transplants by five-year era. The trend is why era matching matters: most of these patients are recent.

Procedures per era

*2025 is a partial year and is shown separately rather than folded into an incomplete 2025–2029 bar.

04 · Tables

All eras (1987–2025)

Group	n	30-day	1-year	3-year	5-year	5-yr 95% CI
Lung only	57,634	95.9%	85.1%	68.9%	55.9%	56–56
Heart-lung	1,632	85.2%	71.3%	56.3%	48.0%	45–50
Lung-liver	187	95.7%	79.8%	70.1%	62.2%	54–70
Lung-kidney/pancreas	89	96.6%	76.9%	59.8%	52.9%	41–64
Lung + other	146	93.1%	81.0%	69.2%	62.8%	53–72

Era-matched (2015 onward)

Group	n	30-day	1-year	3-year	5-year	5-yr 95% CI
Lung only	28,764	97.7%	88.9%	73.2%	59.7%	59–60
Heart-lung	457	92.3%	83.2%	69.2%	61.2%	56–67
Lung-liver	129	97.7%	80.7%	69.2%	61.0%	50–72
Lung-kidney/pancreas	59	94.8%	82.3%	67.1%	60.4%	46–75
Lung + other	128	94.5%	82.3%	67.9%	59.3%	48–71

Read the interval, not the point estimate. The era-matched lung-liver cohort is 129 patients with only 25 still at risk at five years, giving a confidence interval of 50–72%. Differences of a few points are not supportable at this size. These are also highly selected patients — comparable survival is evidence that candidate selection works, not that a second organ is free.