title: Twenty-year experience of lung transplantation at a single center: Influence of recipient diagnosis on long-term survival.
abstract: OBJECTIVE
  The objective of this study was to examine the long-term patient outcomes of lung transplantation in a single center.
  
  
  METHODS
  Between 1983 and 2003, 521 lung transplants were performed in 501 patients. Major indications were cystic fibrosis (n = 124), chronic obstructive pulmonary disease (n = 88), alpha-1 antitrypsin deficiency (n = 63), pulmonary fibrosis (n = 97), primary pulmonary hypertension (n = 35), Eisenmenger syndrome (n = 21), and miscellaneous end-stage lung diseases (n = 93).
  
  
  RESULTS
  The 5-, 10-, and 15-year survivals for all recipients were 55.1% (95% confidence interval: +/-5%), 35.3% (+/-6%), and 26.5% (+/-11%), respectively. The most common causes of death were sepsis and bronchiolitis obliterans syndrome. Despite an increased postoperative mortality rate, patients with primary pulmonary hypertension achieved the best long-term survival (10-year survival: 59%). Recipients with cystic fibrosis without Burkholderia cepacia infection achieved significantly better long-term survival (10-year survival: 52%) than those with Burkholderia cepacia infection (10-year survival: 15%). The 10-year survival was also significantly better in recipients with chronic obstructive pulmonary disease (43%) than in recipients with alpha-1 antitrypsin deficiency (23%). Although the incidence of bronchiolitis obliterans syndrome was similar between recipients with chronic obstructive pulmonary disease (39%) and alpha-1 antitrypsin deficiency (46%), recipients with alpha-1 antitrypsin deficiency died of sepsis more frequently than recipients with chronic obstructive pulmonary disease (27% vs 6%, respectively; P =.0003).
  
  
  CONCLUSIONS
  Although bronchiolitis obliterans syndrome and sepsis still limit the durability of the benefit, lung transplantation returns many patients with end-stage lung disease to active and productive lives. Differences in the complications and long-term survival show the important contribution of the recipient diagnosis to the success of lung transplantation.
authors.affiliation: Toronto Lung Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: Denis
authors.initials: D
authors.lastname: Hadjiliadis
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Pierre
authors.forename: Michael
authors.initials: M
authors.lastname: Hutcheon
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002648:Child; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome