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Heart-lung transplantation: an overview.

V A Starnes1

  • 1Department of Cardiovascular Surgery, Stanford University School of Medicine, California.

Cardiology Clinics
|February 1, 1990
PubMed
Summary
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Heart-lung transplantation offers rehabilitation for end-stage disease. Enhanced immunosuppression and early surveillance significantly reduce obliterative bronchiolitis, a major post-transplant threat.

Area of Science:

  • Cardiology
  • Pulmonology
  • Transplantation Medicine

Background:

  • Heart-lung transplantation is evolving, offering long-term rehabilitation for select patients with end-stage cardiopulmonary and pulmonary disease.
  • Significant advancements have improved feasibility and outcomes, including better immunosuppression and donor procurement techniques.

Purpose of the Study:

  • To evaluate the impact of enhanced immunosuppression and early surveillance on the incidence of obliterative bronchiolitis following heart-lung transplantation.
  • To assess the effectiveness of bronchoscopic surveillance in managing rejection and infection.

Main Methods:

  • Implementation of a triple-drug immunosuppression protocol (cyclosporine, azathioprine, corticosteroids).
  • Increased maintenance immunosuppression with azathioprine to mitigate rejection effects on airway function.

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  • Aggressive bronchoscopic surveillance including transbronchial lung biopsy and bronchoalveolar lavage for early detection of rejection and infection.

    • Main Results:

    • Perioperative mortality reduced from 35% to 16% due to improved recipient and donor selection.
    • Incidence of obliterative bronchiolitis decreased from 62% in Group 1 to 20% in Group 2 patients with enhanced immunosuppression.
    • Bronchoscopic surveillance demonstrated sensitivity and effectiveness in managing rejection and infection, leading to stabilization of airway disease.

    Conclusions:

    • Obliterative bronchiolitis, a major post-transplant threat, is likely caused by repeated rejection episodes or viral pneumonia.
    • Enhanced immunosuppression and early, aggressive bronchoscopic surveillance are crucial for preventing and managing obliterative bronchiolitis.
    • Early recognition and treatment of rejection can reverse airway disease, maintaining normal airway dynamics post-transplantation.