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Heart-lung transplantation: better use of resources
J A Hutter1, P Despins, T Higenbottam
1Department of Surgery, Papworth Hospital, Cambridgeshire, England.
Insights
Combined heart-lung transplantation shows promising survival rates. Early diagnosis of lung rejection via transbronchial biopsy improves outcomes and reduces complications like obliterative bronchiolitis.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Transplantation Immunology
Background:
- Papworth Hospital has extensive experience in combined heart-lung transplantation.
- Advancements in organ preservation and patient management are crucial for successful transplantation.
Purpose of the Study:
- To review the clinical experience and outcomes of combined heart-lung transplantation at Papworth Hospital.
- To assess the effectiveness of current protocols in patient and donor selection, organ preservation, and post-operative management.
Main Methods:
- 31 patients underwent heart-lung transplantation since April 1984.
- Rigorous donor-recipient matching based on serology, morphology, and cytomegalovirus compatibility.
- Development of a pulmonary preservation fluid enabling distant organ procurement with a single pulmonary artery flush.
Main Results:
- No cases of acute cardiac rejection were observed.
- Actuarial survival rates at one and two years were 78% and 70%, respectively.
- Transbronchial biopsy proved effective for early and safe diagnosis of pulmonary rejection, with a low incidence of obliterative bronchiolitis.
Conclusions:
- Careful recipient-donor selection, improved organ preservation, and enhanced patient management contribute to favorable outcomes.
- Early detection and treatment of pulmonary rejection, facilitated by transbronchial biopsy, are key to minimizing complications such as obliterative bronchiolitis.
Purpose:
Our goal was to review the experience at Papworth Hospital, Cambridgeshire, England, with combined heart-lung transplantation.
Patients And Methods:
Since April 1984, 31 patients have undergone heart-lung transplantation. Donors and recipients are carefully matched with regards to serology, morphology, and cytomegalovirus compatibility. A pulmonary preservation fluid has been developed that allows distant organ procurement with a single pulmonary artery flush technique.
Results:
Acute cardiac rejection has not occurred in these patients. Twenty-three patients are alive between two months and over three years following transplantation. The actuarial survival rate at one year is 78 percent, and 70 percent at two years. Three patients died as a result of cytomegalovirus pneumonitis; in two patients, obliterative bronchiolitis developed, and both died, one after an opportunistic infection developed. Three patients died from other causes. The use of transbronchial biopsy of the lung has provided accurate, early, and safe diagnosis of pulmonary rejection.
Conclusion:
Developments in organ preservation and patient management, as well as careful selection of recipients and donors, have led to the effective use of resources and thereby to these good results. In particular, the incidence of obliterative bronchiolitis has been low, which is attributed to the early treatment of pulmonary rejection following diagnosis by transbronchial biopsy.