Related Experiment Videos
Long-term cardiopulmonary function after human heart-lung transplantation
A R Glanville1, J C Baldwin, S A Hunt
1Respiratory Medicine, Concord Hospital, NSW.
Insights
Heart-lung transplant (HLT) recipients show preserved cardiac function but frequent pulmonary issues like airflow limitation. Regular pulmonary function tests are valuable, but invasive cardiac monitoring is not needed annually for long-term survivors.
Area of Science:
- Cardiology
- Pulmonology
- Transplant Surgery
Background:
- Heart-lung transplantation (HLT) is a treatment for end-stage pulmonary hypertension.
- Long-term outcomes and functional status post-HLT require ongoing evaluation.
Purpose of the Study:
- To assess cardiac and pulmonary function in HLT recipients up to four years post-transplant.
- To identify factors influencing long-term survival and complications.
Main Methods:
- Serial annual reviews of 21 HLT recipients.
- Cardiac catheterization and endomyocardial biopsies.
- Pulmonary function testing.
Main Results:
- No biopsy-proven rejection; low incidence of coronary artery disease and pulmonary hypertension.
- Common findings include systemic hypertension and airflow limitation (reduced FEV1/FVC ratio and FEF25-75).
- Survival strongly correlated with resting PaO2 and pulmonary function parameters; obliterative bronchiolitis (OB) was a significant cause of mortality.
Conclusions:
- HLT recipients maintain cardiac function and coronary patency long-term, without severe OB.
- Regular pulmonary function testing is crucial for monitoring.
- Annual invasive cardiac monitoring is not indicated for stable long-term HLT survivors.
Abstract:
We present cardiac and pulmonary function data obtained at serial annual reviews in 21 heart-lung transplant (HLT) recipients followed for up to four years postoperatively, reflecting the entire Stanford experience as of June 1987. A total of 50 cardiac catheterisation procedures and endomyocardial biopsies yielded the following results: rejection on biopsy (0/50) (0% of patients), angiographic coronary artery disease (1/50) (5%), pulmonary hypertension (2/50) (10%), elevated pulmonary vascular resistance (PVR) (1/50) (5%), and low cardiac index (CI) (4/50) (14%). Systemic hypertension was common, with an elevated systemic vascular resistance (SVR) (26/44) (76%) and an elevated mean aortic pressure (MAP) (22/44) (67%). Pulmonary function testing frequently revealed abnormalities. Airflow limitation was manifested by a reduction in both FEV1/FVC ratio (17/50) (52%) and FEF25-75 (30/50) (71%), and was often associated with arterial hypoxaemia (13/50) (52%). Subsequently, five patients with these findings have died with obliterative bronchiolitis (OB), one underwent retransplantation for OB, six have stable OB, and one has progressive OB. Length of survival was highly correlated with the resting PaO2 at the first annual review (r = 0.99) (p less than 0.001), and, to a lesser degree, on the reduction in FEF25-75 (r = 0.73) (p less than 0.05) and FEV1/FVC ratio (r = 0.77) (p less than 0.05). Resting PaO2 was determined by ventilatory (r = 0.80) (p less than 0.001) rather than circulatory factors and all patients with airflow limitation who died had OB at post-mortem examination. These results support the continued study of HLT as a therapeutic modality for selected patients with irreversible pulmonary hypertension. They demonstrate that, in the absence of severe OB, haemodynamics, cardiac function, and coronary patency are preserved for several years after HLT. Whereas the value of regular pulmonary function testing has become evident, there does not appear to be a clinical need for annual surveillance with invasive cardiac procedures in long-term survivors of HLT.