[Lung transplantation--established treatment, uncovered need]

Lung transplantation has been a therapeutic option for end-stage pulmonary disease in Norway since 1990 and there has been an increasing shortage of donor lungs.

The present study evaluates the assessment of a total of 409 patients (212 men and 197 women) referred in the period between 1990 and 2001.

The most frequent diagnoses were chronic obstructive pulmonary disease (45%), a1-antitrypsin deficiency with emphysema (15%), idiopathic pulmonary fibrosis (14%), cystic fibrosis (7%) and sarcoidosis (6%). Among patients with chronic obstructive pulmonary disease, 53% were female. Numbers of referred and transplanted patients per 100 000 inhabitants did not differ significantly between the five health regions of Norway. The number of transplantations has been stable, 10-15 per year, while the number of patients on the waiting list has gradually increased to 30-40. Mean waiting time has increased to 500-600 days. Total mortality rate during assessment and on the waiting list was 41%. Patients with idiopathic pulmonary fibrosis and cystic fibrosis had significantly higher mortality than patients with chronic obstructive pulmonary disease and a1-antitrypsin deficiency with emphysema (63%, 72%, 26%, 21% respectively). Patients with idiopathic pulmonary fibrosis died after a median of 188 days on the waiting list, while patients with cystic fibrosis died after a median of 729 days.

Patients with idiopathic pulmonary fibrosis should be referred earlier and patients with idiopathic pulmonary fibrosis and cystic fibrosis should be given higher priority on the waiting list.