EN-BLOC HEART AND LUNG TRANSPLANTATION IN FINLAND 1988-1996

The purpose of the study was to review the first clinical experience i n combined heart-lung transplantation in our institution. Material. Fr om June 1988 to December 1996 15 en bloc heart and lung transplantatio ns were performed. There were nine men and six women, aged 17-61 (mean 42.3) years. The indications for operation were primary pulmonary hyp ertension with right heart failure in five, Eisenmenger's syndrome in five, pulmonary embolism and right heart failure in three and emphysem a with right heart failure in two cases. Results. The hospital (30 day ) mortality was four patients (26.6 %). The causes of mortality were g raft failure in two cases, infection and bleeding after transbronchial biopsy in one case and sepsis and aspergillosis in one case. Postoper ative complications included eight cytomegalovirus (CMV), two Pneumocy stis Carinii, five bacterial and five fungal (one Aspergillus and four Candida) infections. Rejection episodes (of the lungs) occurred in fo ur patients (in 27 %). During the follow-up to four years two patients developed diabetes mellitus (insulin therapy), one patient renal fail ure (dialysis), two patients tracheal stricture (laser resection), one patient fracture of the spine and one patient epilepsy. One patient d ied from prolonged CMV infection and chronic rejection eight months po stoperatively. Four patients underwent bronchial artery revascularizat ion (two with the internal thoracic artery and two with a vein graft). This was followed by improved airway healing and resistance towards i nfections. After a follow-up to four years 10 patients out of 15 (66.7 %) were living an active life. Conclusion. Combined heart-lung transp lantation offers a good mid-term outcome for patients with end-stage c ardiopulmonary disease. The results compare favourably with the corres ponding international statistics.