300 PATIENTS REFERRED FOR LUNG TRANSPLANTATION - EXPERIENCES OF THE DUTCH LUNG TRANSPLANTATION PROGRAM

In November 1990, a lung transplantation program began at the Universi ty Hospital in Groningen, the Netherlands. As of April 1994, 300 patie nts were referred for lung transplantation and we investigated the dec isions that have been made concerning these referrals up to January 1, 1995. The patients were evaluated according to a stepwise procedure. In stage 1, written information about the referred patients was discus sed during the weekly, multidisciplinary lung transplantation meeting. In this stage, 14% of the patients were rejected and 2% were postpone d. If no major objections for transplantation were identified, the pat ient was invited for a visit to the outpatient clinic, stage 2. The ne wly acquired information from that visit was discussed again at the tr ansplantation meeting. In this stage, 11% of the patients were rejecte d and 18% postponed. The remaining patients underwent an (partial or c omplete) inpatient evaluation, stage 3. From all patients about whom a decision was made in this stage, only 5% were rejected, respectively 35% after partial evaluation and only 1.5% after complete evaluation. A total of 110 patients (37% of all referred patients) were listed for lung transplantation, stage 4, Of the listed patients, 20% died while awaiting an appropriate donor. The group of patients with COPD/emphys ema had by far the lowest death rate on the waiting list. Patients wit h short stature (less than or equal to 1.65 m) had a much higher risk to die on the waiting list compared with patients with longer stature, 42% vs 13%. As of January 1, 1995, 55 patients have undergone transpl antation, which is 50% of all patients on the waiting list and 18% of all referred patients. The stepwise selection procedure identifies pat ients with potential contraindications at an early stage. In this way, unrealistic expectations and unnecessary examinations, expense, and/o r hospital admissions may be prevented. Donor shortage, and thus waiti ng list problems, still remains a significant drawback in the further development of lung transplantation.