ISOLATED LUNG TRANSPLANTATION - INITIAL EXPERIENCE AT THE UNIVERSITY-HOSPITALS-LEUVEN

Lung transplantation nowadays has become a therapeutic modality in the treatment of patients with a variety of end-stage lung diseases. Betw een July 1991 and December 1992, twelve patients received an isolated lung transplant (eight single lungs and four double lungs) at the Univ ersity Hospitals of Leuven. The indication for transplantation was emp hysema in five patients, pulmonary fibrosis in three, cystic fibrosis in three and primary pulmonary hypertension in one. There were four ea rly, in-hospital deaths (30%): two from sepsis and multi-organ failure , one from anoxia following a bronchial dehiscence and another patient exsanguinated following stent insertion for a partial bronchial dehis cence. Three more patients have died during follow-up: two from chroni c respiratory failure secondary to the development of obliterative bro nchiolitis (one at 8 months and one at 17 months), and one from a late bronchovascular fistula 4 months following transplantation. The overa ll actuarial one and two year-survival was 50.0% and 41.6% respectivel y. All patients discharged from hospital were oxygen free with an impr oved lung function and exercise capacity. We conclude that lung transp lantation is a viable therapeutic option for selected patients with en d-stage, irreversible lung disease. In our experience, the bronchial a nastomosis remains an important keystone in the early success. Lung tr ansplantation provides a good quality of life in patients free from in fection and rejection. Nevertheless, chronic rejection resulting in ob literative bronchiolitis is a major problem in long-term survivors.