Experience with lung transplantation

Background. On the basis of a 5-year experience with heart transplantation and long-term animal experimentation, a lung transplantation program was instituted in 1987. After 10 years of experience, the entire patient population was reviewed. Methods. Hospital records were reviewed to evaluate the underlying diagnosis, year of transplantation, type of procedure, and long-term follow-up. The changing scope of indications, procedures performed, and donor criteria, as well as survival data for various subgroups of high-risk candidates, were also examined. Results. A total of 283 heart–lung (n = 46), single-lung (n = 94), and bilateral lung transplantation procedures (n = 143) were performed, with 22 patients undergoing 24 retransplantation procedures. The overall 5-year survival rate was 63%, with no difference between types of operations. Patients with cystic fibrosis, emphysema, pulmonary fibrosis, and secondary pulmonary hypertension showed similar survival rates; primary pulmonary hypertension was associated with a lower long-term survival. In all groups, the bronchiolitis obliterans syndrome occurred at a rate of approximately 15%/year. Conclusions. Acceptable long-term results can be obtained with lung transplantation. Because of expanded indications, no survival benefit was gained in the overall population over a 10-year period. The major obstacle to true long-term survival remains the bronchiolitis obliterans syndrome.