Cardiopulmonary transplantation: experience of a lung transplant group.
Cardiopulmonary transplantation (CPT) is indicated for patients eligible for heart transplantation (HT) or lung transplantation (LT) who have severe concomitant lung or heart disease. Only 2 groups perform CPT in Spain. We report our experience with 18 CPTs representing 8.2% and 5% compared with LT (220) and HT (362), respectively, from February 13, 1990 to October 15, 2002. The mean time on a waiting list was 138 days. The current number of surviving patients is 7 (39%), with a mean follow-up of 602 days (range, 3 to 4627 days). They all remain asymptomatic with normal respiratory function in 4 patients. No cardiac graft rejection has been detected. Two patients experienced sustained gastroparesis during the first year with spontaneous resolution. Death occurred within the first 3 months in 9 patients. These outcomes contrast with the early mortality associated with LT and HT in our series, namely 10.6% and 11%, respectively. The different causes of death were as follows: sepsis and multiorgan failure in 5 patients, hemorrhagic shock in 3 patients, and suture dehiscence and fungal aortic perforation in 1 patient. Late mortalities were recorded in 2 cases. Overall patient survival in our series is lower than that reported by the International Registry (IR), with an early mortality rate of 50% (30% IR). Nevertheless, our survival rate at 10 years after transplantation is 30% (26% IR). We conclude that CPT should be considered despite the greater early morbidity and mortality.
Morales
P
P
Department of Pneumology, La Fe University Hospital, Valencia, Spain. pila1460@separ.es
Almenar
L
L
Torres
J J
JJ
Solé
A
A
Vicente
R
R
Ramos
F
F
Morant
P
P
Lozano
C
C
Calvo
V
V
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006331:Heart Diseases / Q000145:classification / Q000150:complications; D016027:Heart Transplantation / Q000706:statistics & numerical data; D016041:Heart-Lung Transplantation / Q000401:mortality / Q000502:physiology* / Q000706:statistics & numerical data; D006801:Humans; D008171:Lung Diseases / Q000145:classification / Q000150:complications; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis