Initial experience with lung transplantation in Estonia

A lung transplant program in Estonia was initiated in cooperation with the Medical University of Vienna. The first lung transplantation for an Estonian patient was performed in Vienna on April 28, 2009. The waiting list in Estonia was opened on May 28, 2010; the first transplantation was performed on October 7, 2010. The aim of this study was to present our initial results.

All lung transplantations performed in Estonia through the end of January 2012 included 2 female and 3 male patients of age from 52 to 64 years. Data regarding the donor, the transplant operation, postoperative period, and follow-up were extracted from case records.

The cases included 1 bilateral lobar, 3 double, and 1 single lung transplantations. Two patients had chronic obstructive pulmonary disease, one alpha-1 trypsin deficiency, and two idiopathic pulmonary fibrosis. The operative duration varied from 172 to 337 minutes; the ischemia times for the first and second lung ranged from 191 to 351 and 303 to 455 minutes, respectively. Duration of postoperative mechanical ventilation ranged from 2 to 14 days (median 3) and the hospital stay from 28 to 72 days. The following complications were observed: prolonged air leak in 2 patients, one of whom required rethoracotomy; phrenic nerve palsy in 2, atrial fibrillation in 2, and mild renal failure in 1 subject. One patient needed readmission to the intensive care unit owing to acute respiratory failure; one, a tracheostomy for weaning from the ventilator, and one, noninvasive ventilation owing to hypercapnia. All patients remain well at 4-19 months after transplantation. No episodes of acute rejection or bronchiolitis obliterans have been diagnosed.

The first 1.5-year experience with lung transplantation in Estonia has been satisfactory. Although there have been several complications, no posttransplant or waiting list mortality has occurred.