title: Thirteen-year experience in lung transplantation for emphysema.
abstract: BACKGROUND
  Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups.
  
  
  METHODS
  A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years.
  
  
  RESULTS
  The mean age of AAD recipients (49 +/- 6 years) was less than those with COPD (55 +/- 6 years; p < 0.001). Hospital mortality was 6.2%, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p = 0.044). Five-year survival was 58.6% +/- 3.5%, with no difference between COPD (56.8% +/- 4.4%) and AAD (60.5% +/- 5.8%). Five-year survival was better with bilateral-lung transplants (66.7% +/- 4.0%) than with single-lung transplants (44.9% +/- 6.0%, p < 0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p < 0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038).
  
  
  CONCLUSIONS
  AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University Medical Center, St. Louis, Missouri 63110-1013, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Battafarano
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Guthrie
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
authors.forename: John P
authors.initials: JP
authors.lastname: Lynch
authors.forename: Joel D
authors.initials: JD
authors.lastname: Cooper
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality / Q000601:surgery; D011656:Pulmonary Emphysema / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications / Q000401:mortality / Q000601:surgery