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[Heart-lung transplantation and double lung transplantation. 33 cases]
J Cerrina1, E Bavoux, F Le Roy Ladurie
1Groupe de transplantations pulmonaires et cardiopulmonaires de l'Université Paris Sud, Hôpital Marie Lannelongue, Le Plessis-Robinson.
Abstract:
Between June 1986 and October 1989, 29 heart lung transplantations and 4 double lung transplantations were performed at the Marie Lannelongue Hospital, Paris. The early and later course of these patients was studied. The actuarial survival rates at one and two years were 65 percent and 55 percent respectively. Bacterial infection was the main cause of early death. Late morbidity was predominantly due to cytomegalovirus infection and episodes of rejection. Respiratory function, evaluated in 19 long-term survivors, was usually normal. Only 3 patients developed a functional pattern of severe obliterative bronchiolitis probably related to uncontrolled rejections. The indications of the different types of lung transplantation are discussed: in cases of primary pulmonary hypertension or Eisenmenger's complex, heart lung transplantation is the only possible procedure. In patients with respiratory failure without cardiac dysfunction, double lung transplantation gives good functional results and makes an extra heart available for transplantation in another patient. Single lung transplantation, which gives worse functional results with a similar mortality rate, must be reserved for patients who are unable to undergo double lung transplantation.
Insights
Heart-lung and double-lung transplantations showed 65% one-year survival. Bacterial infections caused early deaths, while cytomegalovirus and rejection impacted later survival in lung transplant recipients.
Area of Science:
- Cardiothoracic Surgery
- Pulmonary Medicine
- Transplantation Immunology
Context:
- Review of early and late outcomes for 29 heart-lung and 4 double-lung transplantations performed between June 1986 and October 1989 at Marie Lannelongue Hospital, Paris.
- Analysis of patient survival, causes of mortality, morbidity, and functional respiratory outcomes in a cohort of lung transplant recipients.
Purpose:
- To evaluate the early and late clinical courses of patients undergoing heart-lung and double-lung transplantation.
- To identify major causes of mortality and morbidity post-transplantation.
- To assess long-term respiratory function in survivors and discuss indications for different lung transplantation strategies.
Summary:
- Actuarial survival rates at one and two years were 65% and 55%, respectively. Bacterial infection was the primary cause of early mortality.
- Late morbidity was mainly attributed to cytomegalovirus infection and rejection episodes. Severe obliterative bronchiolitis occurred in 3 patients, likely due to uncontrolled rejection.
- Respiratory function in 19 long-term survivors was generally normal. The study discusses the specific indications for heart-lung, double-lung, and single-lung transplantation based on patient conditions.
Impact:
- Provides insights into the long-term efficacy and challenges of heart-lung and double-lung transplantation.
- Highlights the importance of managing infectious complications and rejection for improved patient outcomes.
- Offers guidance on selecting appropriate lung transplantation techniques (heart-lung, double-lung, single-lung) based on patient-specific cardiac and pulmonary status.