[Lung transplantation in Hanover: an interim balance-sheet after ten years].
BACKGROUND
We reviewed our experience with various forms of lung transplantation (heart-lung [HLTx], bilateral lung [BLTx] and single lung [SLTx]) from December 1987 to September 1998 at Hannover University.


METHODS
In 258 patients 282 procedures (46 HLTx, 142 BLTx and 94 SLTx) were performed. Major indications were pulmonary fibrosis (n = 73), obstructive lung disease (n = 55), cystic fibrosis (n = 48), primary pulmonary hypertension (PPHT, n = 36), secondary pulmonary hypertension (n = 30) and retransplantation (n = 24).


RESULTS
The 1-, 3- and 5-year survival rates in all 258 recipients were 77%, 70% and 63% respectively. Significantly better 1-year survival was noted in patients with cystic fibrosis (90%), pulmonary fibrosis (81%), obstructive lung disease (71%) and secondary pulmonary hypertension (83%) when compared to patients with primary pulmonary hypertension (58%). There was no significant difference in actuarial 1-year survival rates between the different procedures (HLTx 78%, BLTx 77%, SLTx 77%). Bronchiolitis obliterans syndrome (BOS) proved to be the major obstacle for long term survival. Actuarial freedom from BOS was 80% at 1 year and only 45% at 5 years. Various treatment strategies including augmentation of immunosuppression could only temporarily halt the deterioration of lung function in the majority of patients with BOS.


CONCLUSIONS
Lung transplantation provides a true therapeutic option for patients with endstage lung disease. However, improved long term outlook will depend on a better understanding and treatment of bronchiolitis obliterans.
Niedermeyer
J
J
Abteilung Pneumologie, Medizinische Hochschule Hannover. NiedermeyJ.@aol.com
Harringer
W
W
Höper
M M
MM
Wiebe
K
K
Hamm
M
M
Haverich
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000145:classification / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors