SURVIVAL AND FUNCTIONAL OUTCOME AFTER SINGLE AND BILATERAL LUNG TRANSPLANTATION

Background. The experience at Loyola University Chicago was retrospect ively reviewed to evaluate survival and functional outcome after singl e lung transplantation (SLT) and bilateral lung transplantation. (BLT) . Methods. Ninety patients underwent lung transplantation at Loyola Un iversity Chicago between April 1990 and December 1993. Mean age was 45 years (range, 13 to 66 years). Fifty percent were male. Pre-lung tran splant pulmonary diseases were as follows: emphysema and/or chronic ob structive pulmonary hypertension in eight, repeated transplantation fo r obliterative bronchiolitis in four, bronchiectasis in two, bronchoal veolar cell carcinoma in two, sarcoidosis in one, primary obliterative bronchiolitis in one, histiocytosis X in one, and lymphangiomyomatosi s in one. Fifty-seven patients underwent SLT, and 33 had BLT. Maintena nce immunosuppression medications consisted of cyclosporine, azathiopr ine, and prednisone. Results. Perioperative complications were as foll ows: seven of 33 patients bled after BLT, and two of 57 bled after SLT . Bronchial complications were found in six of 66 (9%) BLT anastomoses and eight of 57 (14%) SLT anastomoses. Nine operative deaths occurred in SLT patients: six from allograft failure, one from infection, one from intrapulmonary hemorrhage, and one from bronchial dehiscence. Onl y two patients died in the perioperative period after BLT and that was of infection. Three late deaths occurred after BLT, all as a result o f infection; 13 recipients died after SLT: five of infection, four pat ients from lymphoma, two of pancreatitis, one of tension pneumothorax, and one of pulmonary embolism. For the entire patient population the actuarial 1- and 2-year survival rates were 72% and 68%, respectively. One-year survival rates were significantly better for patients underg oing lung transplantation for obstructive and nonrestrictive lung dise ases than those of patients undergoing lung transplantation for vascul ar or restrictive pulmonary disease. Recipients of BLT had a trend tow ard better survival than recipients of SLT. Lung function 6 months aft er transplantation measured by forced expiratory volume in 1 second wa s significantly better in BLT than SLT, 71% of predicted versus 54%. C onclusions. Patients who undergo BLT have significantly better postope rative pulmonary function than those who undergo SLT. On the basis of the study there was a trend toward better survival with BLT.