Lung transplantation - 10-year experience

Objective: The experience at our institution with various forms of lung tra nsplantation (heart-lung, double lung and single lung) from December 1987 t o September 1998 is reviewed and discussed, Methods: During this decade, 28 2 procedures (46 heart-lungs (HLTx), 142 double lungs (DLTx) and 94 single lungs (SLTx)) have been performed in 258 patients (140 male, 118 female;age :38 +/- 13 years). Major indications included pulmonary fibrosis (n = 73), obstructive lung disease (n = 55), cystic fibrosis (n = 48), primary pulmon ary hypertension (n = 36), secondary pulmonary hypertension (majority Eisen menger's syndrome) (n = 30), and retransplantation (n = 24). Results: Early postoperative mortality (<90 days) was 13.9% (n = 36). The 1-, 3-, and 5-y ear survival rates in all recipients was 77, 70 and 63%, respectively. Ther e was no significant difference in 1-year survival rates between the differ ent procedures (HLTx: 78%, DLTx: 77% SLTx: 77%). Significantly better 1-yea r survival was achieved in patients with cystic fibrosis (89%), pulmonary f ibrosis (81%), obstructive lung disease (74%), and Eisenmenger's syndrome ( 83%) when compared to patients with primary pulmonary hypertension (55%). S urvival rates remained unchanged during this period despite expanding indic ations during the last years. Causes of death in 90 recipients (HLTx: n = 1 9, DLTx: n = 37, SLTx: n:= 34) included sepsis (n = 42), obliterative bronc hiolitis (n = 28), cardiac failure (n = 5), and early allograft dysfunction (n = 2). Freedom from bronchiolitis obliterans syndrome (BOS) (>stage I IS HLT) was 80% at 1 year and 45% at 5 years. Conclusions: Lung transplantatio n offers a hue therapeutic option with good early and midterm results. Yet, chronic graft dysfunction represents a major obstacle for long-term benefi t of this procedure. (C) 1999 Elsevier Science B.V. All rights reserved.