RISK-FACTORS FOR SURVIVAL FOLLOWING COMBINED HEART-LUNG TRANSPLANTATION - THE FIRST 100 PATIENTS

As the numbers of heart and lung transplant recipients have increased it has become possible to identify major risk factors for early (withi n 3 months) and later (after 3 months) death after this procedure. For 100 patients receiving organs between April 1984 and February 1991, a nd followed up until February 1992, patient characteristics, operative details, and early morbidity were assessed for their effects on early and later deaths. Recipient age, sex, and preoperative diagnosis did not have a significant effect on early (within 3 months) or later deat h. Positive cytomegalovirus antibody status of donor or recipient conf erred greater risk of death within 90 days (odds ratio [OR]=3.24, P=0. 06). Greater than 2 L blood in the first 24 hr after operation (OR=6.0 0, P=0.05), and ventilation for greater than 24 hr (OR=4.87, P=0.006) were significant prognostic indicators of early death. After the first 3 months, the main risk factor for death was rejection in the first 3 months (OR=1.38 per episode, P=0.008). Early infection in general and CMV infection in particular were associated with a small increase in risk. This study confirms the importance of matching donor and recipie nt for CMV and shows that difficulties during operation, reflected in postoperative bleeding and ventilation times increased the chance of e arly death. Later death was associated with early acute rejection. A d etrimental effect of infection, including CMV infection, either does n ot exist, or is too small to be detected in a study of this size.