HEART-LUNG TRANSPLANTATION - CARDIAC CLINICOPATHOLOGICAL CORRELATIONS

Reports on heart-lung transplantation emphasize the pathology of the t ransplanted lungs. This study is a clinicopathological assessment of c ardiac pathology in the hearts transplanted as part of the combined he art-lung block. Seventy-five consecutive heart-lung transplants (H-LTx ) performed between 1981 and 1989 were studied. Endomyocardial biopsy, autopsy, and clinical data were analyzed for information on cardiac r ejection, graft coronary disease, transplant survival, and the presenc e of obliterative bronchiolitis and compared with controls. The contro ls consisted of 391 heart transplants (HTx) performed in 361 recipient s over the same time period. Sixty-three adults and nine children rece ived H-LTx (48.6% male; 51.4% female). In this study, H-LTx were perfo rmed primarily for Eisenmenger's complex (33/72) and primary pulmonary hypertension (28/72). At 1 year H-LTx survival was 63.88%, versus 81. 54% in HTx alone and 63.63% in lung transplant recipients without hear t grafts. The results showed that H-LTx patients have less cardiac rej ection compared to patients who undergo HTx alone (p <.005). Only 40% of H-LTx recipients developed acute cardiac rejection in the initial 3 months posttransplantation (post-Tx), compared with 80% of HTx contro ls. Only 4% of H-LTx recipients developed cardiac rejection after the initial 6 months. No cardiac rejection was observed in the initial 5 y ears post-Tx in 49.9% of H-LTx. Graft coronary disease was seen in 7.7 3% of H-LTx within the first 5 years post-Tx compared with 25.87% in H Tx recipients alone (p <.005). Obliterative bronchiolitis (OB) was pre sent in 71.43% of H-LTx with graft coronary disease, compared to OB in only 41.38% of H-LTx without graft coronary disease (p <.05). In conc lusion, H-LTx recipients have less acute cardiac rejection episodes th an HTx recipients alone (p <.005). Most cardiac rejection in H-LTx occ urs within the initial 6 months. In addition, H-LTx recipients develop less graft coronary disease than HTx recipients (p <.005). Obliterati ve bronchiolitis and graft coronary disease may be the result of the s ame immunological process, as 71.43% of H-LTx with graft coronary dise ase also had OB. Survival for H-LTx patients is more similar to that o f lung transplant (LTx) patients alone than that of heart transplants alone, suggesting that it is the pulmonary pathology portion, rather t han the cardiac pathology portion, in combined H-LTx transplants that contributes more to H-LTx survival.