Surgery in heart and lung transplant patients

Heart and lung transplantation is an increasingly successful procedure. After transplant, these patients may need surgery for common diseases and for problems caused by immunosuppression. The purpose of this study was to determine surgical outcomes heart and lung transplant patients after transplantation.

All patients in the cardiopulmonary transplant registry were reviewed. Data collected included sex, age at transplantation, age at subsequent procedure, number and type of surgical procedures performed, number and type of postoperative complications, grade of complications (using the Clavien classification), and outcome (discharge to home, disabled, dead).

During a 15-year period, 222 (64%) of 345 heart or lung transplant patients underwent a surgical procedure. Seven hundred fifty-four procedures were performed (median 3 procedures/patient). Sixty-seven patients suffered 72 complications (10% complication rate). Twenty-one (29%) complications were grade I; 20 (28%) were grade IIA; 21 (29%) were grade IIB; 8 (11%) were grade III; and 2 (3%) were grade IV. Twelve percent of the complications in the heart transplant patients were cardiac in nature, whereas 0% of the complications in the lung transplant patients were pulmonary in nature. There were 475 (63%) discharges to home, 2 (0.2%) inpatient deaths, and 18 (2%) deaths within 30 days; 49 (7%) procedures resulted in disability; and 210 (28%) patients were lost to follow-up.

Heart or lung transplant patients will frequently need subsequent surgical procedures. Overall, the patients tolerated the procedures well, and the morbidity and mortality rates were acceptable. Most complications were not related to the transplanted organ.