Heart-lung transplantation for primary pulmonary hypertension.
BACKGROUND
The operation of choice for primary pulmonary hypertension remains controversial, as heart-lung transplantation, single-lung transplantation, and double-lung transplantation have all been advocated.


METHODS
We reviewed our institution's experience with heart-lung transplantation for primary pulmonary hypertension.


RESULTS
Thirty-nine patients had heart-lung transplantation for primary pulmonary hypertension. Operative mortality rate was 18%, and actuarial survival was 72% at 1 year, 67% at 2 years, and 42% at 5 years. Freedom from obliterative bronchiolitis was 91% at 1 year, 83% at 2 years, and 70% at 5 years. Freedom from obliterative bronchiolitis-related death was 100% at 1 year, 90% at 2 years, and 87% at 5 years. Freedom from accelerated graft coronary disease was 92% at 5 years. The most frequent causes of death were infection, obliterative bronchiolitis, and accelerated graft coronary disease.


CONCLUSIONS
Heart-lung transplantation results in survival comparable to that reported for single or double lung transplantation. Obliterative bronchiolitis is a significant cause of late death but seems to occur less frequently with heart-lung transplantation than with lung transplantation alone. Accelerated coronary graft disease is rare in the first 5 years after transplantation.
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology; D002648:Child; D003327:Coronary Disease / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection; D016041:Heart-Lung Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate