LUNG TRANSPLANTATION - THE CLEVELAND-CLINIC EXPERIENCE

BACKGROUND Lung transplantation has been steadily developing as a ther apeutic option for end-stage lung disease. METHODS Retrospective analy sis of all 26 patients who underwent lung transplantation at the Cleve land Clinic Foundation between February 1990 and February 1992. RESULT S Nineteen single-lung transplantations and seven bilateral lung trans plantations were performed. The 1-year actuarial survival for all reci pients was 65%. A trend was noted towards better survival in recipient s with emphysema (100%) and poorer survival in those with pulmonary hy pertension (37.5%). Fungal sepsis and reimplantation lung injury were the most common causes of death, and most deaths (8 of 9) occurred wit hin the first 4 weeks. Of 119 pulmonary complications, 82% occurred in the first 3 months, with infection (39%) and acute rejection (29%) be ing the most common. Bacterial and fungal infections occurred mainly i n the first month, and cytomegalovirus infections occurred mainly in t he second and third months. The majority of survivors have shown impro vement in functional status. CONCLUSIONS The early perioperative and 1 -month post-transplantation period appears critical to long-term survi val. Even though the complications are numerous, they are usually mana geable and, in general, do not result in long-term morbidity.