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Improved survival after heart-lung transplantation
P M McCarthy1, V A Starnes, J Theodore
1Department of Cardiovascular Surgery, Stanford University Medical Center, CA 94305.
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1990
Summary
Adding azathioprine to immunosuppression significantly improved heart-lung transplant survival by reducing mortality and obliterative bronchiolitis. Early detection of rejection and infection also contributed to better outcomes in heart-lung transplant recipients.
Area of Science:
- Cardiovascular Surgery
- Immunosuppression Therapy
- Transplantation Medicine
Background:
- Heart-lung transplantation is a complex procedure with significant associated mortality and morbidity.
- Optimizing immunosuppression regimens is crucial for improving long-term graft survival and patient outcomes.
- Obliterative bronchiolitis remains a major challenge in heart-lung transplant recipients.
Purpose of the Study:
- To evaluate the impact of adding azathioprine to a cyclosporine and prednisone immunosuppression regimen in heart-lung transplant recipients.
- To compare perioperative mortality, incidence of obliterative bronchiolitis, and long-term survival between two immunosuppression protocols.
- To assess the role of routine bronchoscopic surveillance in early detection of rejection and infection.
Main Methods:
- Retrospective comparison of 30 heart-lung transplant patients (group 1) receiving cyclosporine and prednisone (March 1981-February 1986) versus 32 patients (group 2) receiving cyclosporine, prednisone, and azathioprine (post-February 1986).
- Analysis of perioperative mortality, development of obliterative bronchiolitis, causes of death, and survival rates.
- Comparison of outcomes in group 2 patients with a historical cohort of heart transplant recipients.
Main Results:
- Perioperative mortality was significantly lower in group 2 (16%) compared to group 1 (35%).
- Incidence of obliterative bronchiolitis was reduced in group 2 (20%) versus group 1 (63%).
- Group 2 demonstrated improved survival rates at 1, 2, and 3 years post-transplant (73%, 73%, 65%) compared to group 1 (60%, 50%, 43%; p<0.05).
Conclusions:
- Augmented immunosuppression with azathioprine, combined with decreased perioperative mortality and routine bronchoscopic surveillance, led to improved survival in heart-lung transplant recipients.
- Earlier recognition of rejection and infection in the augmented immunosuppression group resulted in a decrease in the severity of obliterative bronchiolitis.
- The enhanced immunosuppression protocol offers a significant survival benefit for heart-lung transplant patients.