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Optimization of the Cuff Technique for Murine Heart Transplantation
Published on: June 26, 2020
Intermediate-term results of heart-lung transplantation for cystic fibrosis
B P Madden1, M E Hodson, V Tsang
1Harefield Hospital, Middlesex, UK.
Insights
Heart-lung transplantation for cystic fibrosis shows encouraging intermediate-term survival. Key challenges include donor organ shortage and obliterative bronchiolitis, impacting long-term outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Cystic fibrosis (CF) is a progressive genetic disorder leading to end-stage lung disease.
- Heart-lung transplantation (HLT) offers a potential solution for patients with end-stage CF.
- Intermediate-term outcomes of HLT for CF require further evaluation.
Purpose of the Study:
- To report the intermediate-term outcomes of heart-lung transplantation in patients with end-stage cystic fibrosis.
- To assess patient survival, complication rates, and functional improvements following HLT.
- To identify factors influencing outcomes and long-term challenges in CF patients undergoing HLT.
Main Methods:
- Retrospective analysis of 79 patients undergoing HLT for end-stage CF between 1984 and 1991.
- Evaluation of actuarial patient survival, complication incidence (rejection, infection, lymphoproliferative disorders, obliterative bronchiolitis), and lung function.
- Assessment of risk factors, including diabetes mellitus and other comorbidities, on survival.
Main Results:
- Overall actuarial survival was 69% at 1 year, 52% at 2 years, and 49% at 3 years.
- Significant improvements in lung function (FEV1, FVC) were observed post-transplantation, maintained long-term.
- Common complications included acute rejection (92%) and obliterative bronchiolitis (17% at 1 year, 48% at 3 years).
- Diabetes mellitus and other high-risk factors showed slightly reduced survival rates.
- No coronary artery disease was detected in patients undergoing angiography.
Conclusions:
- Heart-lung transplantation provides significant functional benefit and encouraging intermediate-term survival for end-stage CF patients.
- Obliterative bronchiolitis and donor organ shortage remain critical obstacles.
- Successful management of lymphoproliferative disorders and the potential for domino heart transplantation are noted.
Abstract:
Between September, 1984, and March, 1991, 79 patients underwent heart-lung transplantation for end-stage cystic fibrosis at the Harefield Hospital. Short-term outcome has already been reported, and we now present intermediate-term results. The overall actuarial patient survival was 69% at 1 year, 52% at 2 years, and 49% at 3 years. 17 patients had diabetes mellitus with a survival of 62% to 1 year and 51% to 2 years. 23 patients had one or more other possible high-risk factors, and survival of these patients was 64% at 1 year and 57% at 2 years, compared with 71% and 49%, respectively, in the low-risk group (n = 56). Pseudomonas aeruginosa infection was the most common respiratory infection encountered postoperatively. 92% of patients had at least one episode of acute rejection during the first 3 postoperative months. Lung function was greatly improved after transplantation, the mean forced expiratory volume in 1 s and forced vital capacity increasing from 22% and 35% predicted, respectively, preoperatively to 68% and 70% predicted, respectively, by the sixth postoperative month. This improvement was maintained at 1, 2, and 3 years after transplantation. Lymphoproliferative disorders (4 patients) were successfully treated. Obliterative bronchiolitis developed in 17 patients and the cumulative probability of getting this complication at 1, 2, and 3 years postoperatively was 17%, 23%, and 48%, respectively. Overall, 7 patients were retransplanted. There was no coronary artery disease in the 37 patients who underwent coronary angiography at 1 year, 14 at 2 years, and 9 at 3 years after surgery. 58 patients donated their hearts for subsequent "domino" heart transplantation. Our 5 1/2-year experience with heart-lung transplantation is encouraging but the shortage of donor organs and the complication of obliterative bronchiolitis are the two main obstacles to be overcome.
