SINGLE-LUNG TRANSPLANTATION - A TEMPORAL LOOK AT REJECTION, INFECTION, AND SURVIVAL

Single lung transplantation (SLT) has emerged as routine therapy for s elected patients with end-stage lung disease. This study examines the incidence of rejection, infection, and survival during the first postt ransplant year. Twenty-one patients (12 male, 9 female; mean age 46 +/ - 13 years) underwent 23 SLT procedures (12 left, 11 right lung). Indi cations were pulmonary fibrosis in six, emphysema in seven, primary pu lmonary hypertension in three, Eisenmenger's syndrome in one, pulmonar y veno-occlusive disease in one, a-1 antitrypsin deficiency in two, CR EST syndrome in one, and retransplantation (graft failure and bronchio litis obliterans) in two. All were maintained on triple immunotherapy. Survival at 1 year was 100%. The five patients with preoperative pulm onary hypertension had normal hemodynamics at follow up. Freedom from event at 1 year was rejection 23 per cent, all infections 6 per cent, viral 40 per cent, bacterial 55 per cent, fungal 74 per cent. At 1 yea r, cumulative incidence (events/patient-year) was rejection 1.61, all infections 2.18, viral 0.78, bacterial 1.12, fungal 0.28. Two of 21 pa tients have developed bronchiolitis obliterans at 1 and 2 years posttr ansplant. SLT provided safe, effective treatment for a wide variety of end-stage lung diseases. Rejection and infection, although common, ma y be safely treated with resolution.