Download PDF
Semin Respir Crit Care Med 2001; 22(5): 479-488
DOI: 10.1055/s-2001-18420
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Lung and Heart-Lung Transplantation: Overview of Results

Elbert P. Trulock
  • Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, and Lung Transplantation Program, Barnes-Jewish Hospital, St. Louis, Missouri
Further Information

Publication History

Publication Date:
14 November 2001 (online)

    Permissions and Reprints

ABSTRACT

During the last decade, activity in lung transplantation increased rapidly to a plateau of approximately 900 transplants per year in the United States, and it is unlikely to increase further unless the supply of useable donor organs can be expanded. However, the demand for lung transplantation has continued to rise, and the median waiting time for lung transplantation in the United States is approaching 2 years. The main indications for lung transplantation have been chronic obstructive pulmonary disease, α1-antitrypsin deficiency emphysema, cystic fibrosis, idiopathic pulmonary fibrosis, primary pulmonary hypertension, and Eisenmenger's syndrome. Overall, survival after lung transplantation has been good, with 1-, 3-, and 5-year survival rates of 75, 58, and 44%, respectively, and the results have been improving. Chronic rejection and infection have been the main causes of medium-term mortality, and the high prevalence of chronic rejection remains a barrier to better outcomes. Quality of life has been enhanced by lung transplantation, but the posttransplantation immunosuppressive regimen has been associated with considerable morbidity.

KEYWORD

Lung transplantation - organ allocation - lung transplant activity - lung transplant outcomes

REFERENCES

  • 1 1999 Annual Report of the US Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network: Transplant Data: 1989-1998. US Dept of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation, Rockville, MD; UNOS, Richmond, VA; 1999
    Google Scholar
  • 2 United Network for Organ Sharing (UNOS) data. Available at: http://www.unos.org/frame_default.asp
    Google Scholar
  • 3 Hosenpud J D, Bennett L E, Keck B M, Boucek M M, Novick R J. The Registry of the International Society for Heart and Lung Transplantation: seventeenth official report-2000.  J Heart Lung Transplant . 2000;  19 909-931
    CrossrefPubMedGoogle Scholar
  • 4 ISHLT Seventeenth Annual Data Report, April 2000. Available at: http://www.ishlt.org/regist_heart-lung_report_toc.htm
    Google Scholar
  • 5 Evans R W, Orians C E, Ascher N L. The potential supply of donor organs: an assessment of the efficiency of organ procurement efforts in the United States.  JAMA . 1992;  267 239-246
    CrossrefPubMedGoogle Scholar
  • 6 1994 Annual Report of the US Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network-Transplant Data: 1988-1993. UNOS, Richmond, VA, and the Division of Organ Transplantation, Bureau of Health Resources Development, Health Resources and Services Administration, US Dept of Health and Human Services, Bethesda, MD; 1994
    Google Scholar
  • 7 Organ Procurement and Transplantation Network: final rule. 42 CFR Part 121. Federal Register 1998 63(no. 63): 16296-16338
    Google Scholar
  • 8 Organ Procurement and Transplantation Network: final rule. 42 CFR Part 121. Federal Register 1998 64(no. 202): 56650-56661
    Google Scholar
  • 9 Hayden A M, Robert R C, Kriett J M, Smith C M, Nicholson K, Jamieson S W. Primary diagnosis predicts prognosis of lung transplant candidates.  Transplantation . 1993;  55 1048-1050
    PubMedGoogle Scholar
  • 10 Kadikar A, Maurer J, Kesten S. The six-minute walk test: a guide to assessment for lung transplantation.  J Heart Lung Transplant . 1997;  16 313-319
    PubMedGoogle Scholar
  • 11 D'Armini A M, Callegari G, Vitulo P. Risk factors for early death in patients awaiting heart-lung or lung transplantation.  Transplantation . 1998;  66 123-127
    PubMedGoogle Scholar
  • 12 Hosenpud J D, Bennett L E, Keck B M, Edwards E B, Novick R J. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet . 1998;  351 24-27
    CrossrefPubMedGoogle Scholar
  • 13 Geertsma A, TenVergert E M, Bonsel G J, de Boer J W, van der Bij W. Does lung transplantation prolong life?.  <~>A comparison with and without transplantation. J Heart Lung Transplant . 1998;  17 511-516
    PubMedGoogle Scholar
  • 14 UNOS data obtained by request. Communication from Leah Bennett, Ph.D. UNOS, Richmond, VA. Received on September 29, 2000
    Google Scholar
  • 15 Levine S M, Bryan C L. Bronchiolitis obliterans in lung transplant recipients: the ``thorn in the side'' of lung transplantation.  Chest . 1995;  107 894-897
    PubMedGoogle Scholar
  • 16 Cooper J D, Billingham M, Egan T. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts.  J Heart Lung Transplant . 1993;  12 713-716
    PubMedGoogle Scholar
  • 17 Trulock E P. Flexible bronchoscopy in lung transplantation.  Clin Chest Med . 1999;  20 77-87
    PubMedGoogle Scholar
  • 18 Bando K, Paradis I L, Similo S. Obliterative bronchiolitis after lung and heart-lung transplantation: an analysis of risk factors and management.  J Thorac Cardiovasc Surg . 1995;  110 4-14
    CrossrefPubMedGoogle Scholar
  • 19 Girgis R A, Tu I, Berry G J. Risk factors for the development of obliterative bronchiolitis after lung transplantation.  J Heart Lung Transplant . 1996;  15 1200-1208
    PubMedGoogle Scholar
  • 20 Sharples L D, Tamm M, McNeil K, Higenbottam T, Stewart S, Wallwork J. Development of bronchiolitis obliterans syndrome in recipients of heart-lung transplantation: early risk factors.  Transplantation . 1996;  61 560-566
    CrossrefPubMedGoogle Scholar
  • 21 Hussain A N, Siddiqui M T, Holmes E W. Analysis of risk factors for the development of bronchiolitis obliterans.  Am J Respir Crit Care Med . 1999;  159 829-833
    CrossrefPubMedGoogle Scholar
  • 22 Kroshus T J, Kshettry V R, Savik K, John R, Hertz M I, Bolman III M R. Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation.  J Thorac Cardiovasc Surg . 1997;  114 195-202
    CrossrefPubMedGoogle Scholar
  • 23 Valentine V G, Robbins R C, Berry G J. Actuarial survival of heart-lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis.  J Heart Lung Transplant . 1996;  15 371-383
    PubMedGoogle Scholar
  • 24 Maurer J R, Tewari S. Nonpulmonary medical complications in the intermediate and long-term survivor.  Clin Chest Med . 1997;  18 367-382
    CrossrefPubMedGoogle Scholar
  • 25 Epstein S. Post-transplantation bone disease: the role of immunosuppressive agents and the skeleton.  J Bone Miner Res . 1996;  11 1-7
    PubMedGoogle Scholar
  • 26 Aris R M, Neuringer I P, Weiner M A, Egan T M, Ontjes D. Severe osteoporosis before and after lung transplantation.  Chest . 1996;  109 1176-1183
    CrossrefPubMedGoogle Scholar
  • 27 Shane E, Papadopoulos A, Staron R B. Bone loss and fracture after lung transplantation.  Transplantation . 1999;  68 220-227
    PubMedGoogle Scholar
  • 28 Penn I. Neoplastic complications of organ transplantation. In: Ginns LC, Cosimi AB, Morris PJ, eds. Transplantation Malden, MA: Blackwell Science Inc 1999: 770-786
    Google Scholar
  • 29 Trulock E P. State of the art: lung transplantation.  Am J Respir Crit Care Med . 1997;  155 789-818
    CrossrefPubMedGoogle Scholar
  • 30 Howard D A, Iademarco E, Trulock E P. The role of cardiopulmonary exercise testing in lung and heart-lung transplantation.  Clin Chest Med . 1994;  15 405-420
    PubMedGoogle Scholar
  • 31 Schwaiblmair M, Reichenspurner H, Muller C. Cardiopulmonary exercise testing before and after lung and heart-lung transplantation.  Am J Respir Crit Care Med . 1999;  159 1277-1283
    PubMedGoogle Scholar
  • 32 Wang X N, Williams T J, McKenna M J. Skeletal muscle oxidative capacity, fiber type, and metabolites after lung transplantation.  Am J Respir Crit Care Med . 1999;  160 57-63
    PubMedGoogle Scholar
  • 33 Lands L C, Smountas A A, Mesianno G. Maximal exercise capacity and peripheral skeletal muscle function following lung transplantation.  J Heart Lung Transplant . 1999;  18 113-120
    CrossrefPubMedGoogle Scholar
  • 34 Ramsey S D, Patrick D L, Lewis S, Albert R K, Raghu G, and the University of Washington Lung Transplant Study Group. Improvement in quality of life after lung transplantation: a preliminary study.  J Heart Lung Transplant . 1995;  14 870-877
    PubMedGoogle Scholar
  • 35 Gross C, Savik K, Bolman R M, Hertz M I. Long-term health status and quality of life outcomes of lung transplant recipients.  Chest . 1995;  108 1587-1593
    CrossrefPubMedGoogle Scholar
  • 36 TenVergert E M, Essink-Bot M-L, Geertsma A, van Enckevort J P, de Boer J W, van der Bij W. The effect of lung transplantation on health-related quality of life: a longitudinal study.  Chest . 1998;  113 358-364
    CrossrefPubMedGoogle Scholar
  • 37 van den Berg W K J, Geertsma A, van der Bij W. Bronchiolitis obliterans syndrome after lung transplantation and health-related quality of life.  Am J Respir Crit Care Med . 2000;  161 1937-1941
    PubMedGoogle Scholar
  • 38 Ramsey S D, Patrick D L, Albert R K, Larson E B, Wood D E, Raghu G. The cost-effectiveness of lung transplantation: a pilot study.  Chest . 1995;  108 1594-1601
    CrossrefPubMedGoogle Scholar
  • 39 Lanuza D M, Lefavier C, McCabe M, Farcas G A, Garrity Jr E. Prospective study of functional status and quality of life before and after lung transplantation.  Chest . 2000;  118 115-122
    CrossrefPubMedGoogle Scholar
  • 40 Gartner S H, Sevick M A, Keenan R J, Chen G J. Cost-utility of lung transplantation: a pilot study.  J Heart Lung Transplant . 1997;  16 1129-1134
    PubMedGoogle Scholar
      >