CAUSES OF DEATH IN LUNG-TRANSPLANT RECIPIENTS

Between November 1983 and September 1992, The Toronto Lung Transplant Program performed 131 lung transplantations in 122 recipients; 53 sing le lung transplantations and 78 double lung transplantations. Forty-fi ve patients died, 25 (47%) in the single lung transplantation and 20 ( 25%) in the double lung transplantation groups. We retrospectively rev iewed the hospital charts of all deceased recipients and the postmorte m reports of the 35 patients (20 single lung transplantations and 15 d ouble lung transplantations) who had autopsies. Preoperative single lu ng transplantation diagnoses included pulmonary fibrosis, (n = 17) obs tructive disease (n = 6) and vascular disease (n = 2). Preoperative di agnosis of double lung transplantation included pulmonary fibrosis (n = 2), obstructive disease (n = 6), septic lung disease (n = 9), and va scular disease (n = 3). The most common cause of death in single lung transplantation was infection. Five patients died of bronchiolitis obl iterans, and five more had bronchiolitis obliterans lesions present at autopsy that were not a direct cause of death. Diagnosis of primary d isease was made in 23 of 25 single lung transplantations antemortem an d 2 of 25 at autopsy. Autopsy diagnoses were disseminated Aspergillus and cytomegalovirus infection. In double lung transplantations, infect ion was also the primary cause of death; in three other patients, airw ay dehiscence preceded infection. Bronchiolitis obliterans was the sec ond most common cause of death and was also present in four patients d ying of infection. All double lung transplantation diagnoses were made antemortem. We concluded that infection and then bronchiolitis oblite rans are the primary causes of death after lung transplantation. Altho ugh infection is a major cause both early and late after transplantati on, bronchiolitis obliterans is an important factor in transplantation only late after the operation.