DOUBLE-LUNG TRANSPLANTATION IN MECHANICALLY VENTILATED PATIENTS WITH CYSTIC-FIBROSIS

Many lung transplant programs consider ventilator dependence as a cont raindication for transplantation. Among 54 patients in whom bilateral lung transplantations for cystic fibrosis were performed by the Joint Marseille-Montreal Lung Transplant Program, 10 were ventilator depende nt. Three of them died in the early postoperative period (30%): 2 as a result of cerebral anoxia and sepsis, 1 of Pseudomonas cepacia pneumo nia. Two patients died at 15 and 19 months after transplantation of ob literative bronchiolitis and secondary bacterial pneumonitis. Another 2 patients in whom obliterative bronchiolitis developed underwent retr ansplantation with a heart-lung block; 1 of those was operated on at 1 2 months and is well at 29 months after his initial transplantation; t he second was operated on at 34 months and died of primary graft failu re. Three other patients are alive and well at 3, 11, and 14 months af ter transplantation. Actuarial survival at 1 year was 70%. The postope rative course and the infectious and rejection complications were no d ifferent from those in patients who underwent transplantation while sp ontaneously breathing. Obliterative bronchiolitis developed in 66% of patients at risk (2 of 6 patients surviving more than 6 months). We co nclude that transplantation in mechanically ventilated patients with c ystic fibrosis is not associated with an increase in morbidity or mort ality after bilateral lung transplantation. Long-term survival, as in patients who undergo transplantation while spontaneously breathing, is limited by the development of obliterative bronchiolitis.