title: Single lung transplantation: a temporal look at rejection, infection, and survival.
abstract: Single lung transplantation (SLT) has emerged as routine therapy for selected patients with end-stage lung disease. This study examines the incidence of rejection, infection, and survival during the first posttransplant year. Twenty-one patients (12 male, 9 female; mean age 46 +/- 13 years) underwent 23 SLT procedures (12 left, 11 right lung). Indications were pulmonary fibrosis in six, emphysema in seven, primary pulmonary hypertension in three, Eisenmenger's syndrome in one, pulmonary veno-occlusive disease in one, a-1 antitrypsin deficiency in two, CREST syndrome in one, and retransplantation (graft failure and bronchiolitis obliterans) in two. All were maintained on triple immunotherapy. Survival at 1 year was 100%. The five patients with preoperative pulmonary hypertension had normal hemodynamics at follow up. Freedom from event at 1 year was rejection 23 per cent, all infections 6 per cent, viral 40 per cent, bacterial 55 per cent, fungal 74 per cent. At 1 year, cumulative incidence (events/patient-year) was rejection 1.61, all infections 2.18, viral 0.78, bacterial 1.12, fungal 0.28. Two of 21 patients have developed bronchiolitis obliterans at 1 and 2 years posttransplant. SLT provided safe, effective treatment for a wide variety of end-stage lung diseases. Rejection and infection, although common, may be safely treated with resolution.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Vanderbilt Transplant Center, Nashville, Tennessee.
authors.forename: W H
authors.initials: WH
authors.lastname: Frist
authors.forename: J E
authors.initials: JE
authors.lastname: Loyd
authors.forename: W H
authors.initials: WH
authors.lastname: Merrill
authors.forename: J R
authors.initials: JR
authors.lastname: Stewart
authors.forename: J S
authors.initials: JS
authors.lastname: Dummer
authors.forename: S J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: B
authors.initials: B
authors.lastname: Walker
authors.forename: H W
authors.initials: HW
authors.lastname: Bender
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors