Objective: The purpose of this study was to compare outcomes after heart-lu
ng or double-lung transplantation in patients undergoing transplantation be
cause of end-stage suppurative lung disease. Methods: We reviewed our exper
ience in patients with cystic fibrosis or bronchiectasis who had heart-lung
or double-lung transplantation between January 1988 and September 1997, Tw
enty-three patients (14 male, 21 cystic fibrosis) had heart-lung transplant
ation and 24 patients (8 male, 19 cystic fibrosis) had double-lung transpla
ntation. There were no statistically significant differences between the gr
oups in age, weight, preoperative creatinine level, cytomegalovirus status,
maintenance immunosuppression, or donor demographics. Patients received in
duction therapy with monoclonal (OKT3) or polyclonal (rabbit anti-thymocyte
globulin) antibody, Results: Sixteen of 24 patients had double-lung transp
lantation after 1994 whereas 13 of 22 patients had heart-lung transplantati
on before 1991, allowing longer follow-up for the heart-lung group. Mean wa
iting times for transplantation were 270 +/- 245 days (heart-lung) and 361
+/- 229 days (double-lung; P =.20). The 1-, 3-, and 5-year actuarial surviv
al figures were respectively 86%, 82%, and 65% (heart-lung) and 96%, 75%, a
nd unavailable (double-lung; P = no significant difference). The 1-, 3-, an
d 5-year rates of freedom from obliterative bronchiolitis were respectively
77%, 61%, and 45% (heart-lung) and 86%, 78%, and unavailable (double-lung;
P = no significant difference). Linearized overall infection rates (events
/100 patient-days) were 2.05 +/- 0.33 (heart-lung) and 2.34 +/- 0.34 (doubl
e-lung; P = NS) at 3 months. Thirty-day survival was 100% (heart-lung) and
96% (double-lung). There were 7 late deaths among heart-lung recipients (3
obliterative bronchiolitis, 2 infection, 0 graft coronary artery disease, 3
other) whereas 2 late deaths related to obliterative bronchiolitis occurre
d in double-lung recipients. Graft coronary artery disease tall stenoses <
50%) affected 15% of heart-lung survivors, whereas 3 double-lung recipients
(12.5%) required either bronchial dilatation or stenting. Conclusion: Hear
t-lung and double-lung transplantation provide similar palliation for patie
nts with end-stage suppurative lung disease. Therefore double-lung transpla
ntation should be the preferred operation for most patients with end-stage
suppurative lung disease.