Heart-lung versus double-lung transplantation for suppurative lung disease

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.