Elsevier

Transplantation Proceedings

Volume 40, Issue 9, November 2008, Pages 3085-3087
Transplantation Proceedings

Lung transplantation
Outcome
Results of Lung Transplantation in Patients With Cystic Fibrosis

https://doi.org/10.1016/j.transproceed.2008.08.120Get rights and content

Abstract

Lung transplantation (LT) is the only available option for patients with cystic fibrosis (CF) with end-stage lung disease. We reviewed our experience with LT in patients with end-stage CF (CFLT) to identify variables associated with survival and to compare the results with other indications for LT (OILT). Between October 1993 and October 2007, we performed 259 consecutive LTs in 250 patients for treatment of various end-stage pulmonary conditions. The indications for LT were CF in 78 patients idiopathic pulmonary fibrosis in 76, COPD in 64, bronchiectasis in 11, alfa-1-antitrypsin deficit in 5, primary pulmonary hypertension in 4, bronchiolitis obliterans syndrome in 4, and other indications in 11. Our study group comprised 78 patients with CF (30.11%) (CFLT). We observed significant differences in the actuarial survival between the CFLT and OILT groups. Perioperative mortality and the incidence of bronchiolitis obliterans syndrome were comparable in both groups. We found that in patients with CF, LT performed under urgency code (mechanical ventilation) showed no significant difference from LT performed electively insofar as long-term survival, early death, or perioperative death. The functional results in the CFLT group were excellent. We observed significant improvement in PaO2, PaCO2, forced vital capacity, and forced expiratory volume in the first second of expiration at 6, 12, and 36 months compared with the pretransplantation baseline values.

Section snippets

Patients and Methods

Between October 1993 and October 2007, we performed 259 consecutive LTs in 250 patients to treat various end-stage pulmonary conditions, including CF in 78 patients, idiopathic pulmonary fibrosis in 76, chronic obstructive pulmonary disease in 64, bronchiectasis in 11, alfa-1-antitrypsin deficit in 5, primary pulmonary hypertension in 4, bronchiolitis obliterans syndrome (BOS) in 4, and other indications in 11. Our study group comprised 78 patients (30.11%) who had been diagnosed with CF

Results

Seventy-eight LTs were performed in patients with CF, most of whom were ambulatory. Twenty-three patients (29.5%) received transplants under an urgency code because of onset of an irreversible respiratory crisis that required mechanical ventilation; giving them priority over the remaing patients who were on the active waiting list for a lung. In most patients (91%), bipulmonary LT was performed. The mean (SD) ischemia time for the first and second lungs was 337 (56) minutes (range, 230–450 min

Discussion

Lung transplantation is the only available therapy for patients with CF with end-stage lung disease. Several series have shown that the predominant operative approach is bilateral LT. The 1-year survival rate after LT has improved dramatically to 79% to 84%.4, 5 In our series, we observed significant differences in actuarial survival between the CFLT and the OILT groups, though perioperative mortality was similar in both groups. Ventilator dependence has traditionally been considered a relative

References (6)

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Cited by (6)

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  • Guidelines for the Selection of Lung Transplantation Candidates

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    In addition, the multisystemic affectation of CF makes this population peculiar. Despite all these added problems, it should be stated that the survival of CF transplanted patients is very good, in adults as well as in children.4,31–39 The infections by germs that are resistant to antibiotics can increase the risk of LT for these patients although this fact does not constitute an absolute contraindication for LT. It has been reported that the colonization by pan-resistant Pseudomonas aeruginosa does not influence the short-term results of LT.37,40–42 Nor are the colonizations by resistant Staphylococcus aureus meticilin, Stenotrophomonas maltophilia, Alcaligenes xylosoxidans or Aspergillus fumigatus2 considered contraindications.

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