A DECADE OF LUNG TRANSPLANTATION

Objective The experience accrued at the University of Pittsburgh betwe en March 1982 and December 1992 in the various forms of lung transplan tation, including heart-lung, double lung, and single lung, is discuss ed. Summary Background Data Heart-lung (n = 97) was the most commonly performed operation followed by double lung (n = 80) and single lung ( n = 68). Major indications included primary pulmonary hypertension (n = 76), obstructive lung disease (n = 57), Eisenmenger's syndrome (n = 42), cystic fibrosis (n = 32), and retransplantation (n = 13). Since M ay 1991, 115 procedures have been performed and heart-lung transplanta tion has decreased from 61% to 15% of the cases with a corresponding d oubling in double lung from 24% to 43% and single lung from 15% to 42% . Results The 1 , 2-, and 5-year survival rates in all 232 recipients were 61%, 55%, and 44%, respectively. The actuarial survival rate was significantly better for those 107 recent recipients compared to the 1 25 early recipients (70% vs. 61%). Overall, the 63 single (70%) and 74 double (65%) lung procedures were more successful than heart-lung tra nsplantation (53%). Recently, however, lung transplantation has been a ssociated with an improvement in the survival rate from 48% to 72%. Th e survival rate has also improved from 53% to 77% for single lung tran splant recipients. The causes of death in 106 recipients included infe ction (n = 40), early allograft dysfunction (n = 23), obliterative bro nchiolitis (n = 13), and inoperative bleeding (n = 10). Poor outcomes also included technical problems (n = 6), lymphoma (n = 4), acute reje ction (n = 3), diaphragmatic paralysis (n = 2), multisystem organ fail ure (n = 2), stroke (n = 2), liver failure (n = 1), and airway dehisce nce (n = 1). Conclusions The long-term outlook for lung transplant rec ipients has improved. There appears to be significant conservation of organs with single lung and double lung transplantation, finding great er acceptance for diseases once exclusively treated by heart-lung tran splantation alone. The improved long-term outlook will be dependent up on better treatment for chronic rejection of the airways that histolog ically is defined by obliterative bronchiolitis.