The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart-lung transplantation.
OBJECTIVE
To review the 13-year clinical experience of a single center's adult lung transplantation program.


METHODS
From January 1992 to December 2003, 369 lung transplantations were performed on 362 patients. Single lung transplantation was performed in 234 cases, double lung transplantation in 113 cases (comprising en-bloc double lung transplantation in 44 cases and bilateral sequential lung transplantation in 69 cases), heart-lung transplantation in 21 cases, and lobe of lung transplantation in 1 case. Recipient diagnoses included chronic obstructive pulmonary disease (COPD) (n = 175), alpha1 antitrypsin (alpha1AT) deficiency (n = 86), cystic fibrosis (n = 36), pulmonary fibrosis (n = 20), Eisenmenger syndrome and secondary pulmonary hypertension (n = 24), primary pulmonary hypertension (n = 8), sarcoidosis (n = 7), silicosis (n = 4), bronchiectasis (n = 1), and graft-vs-host disease (n = 1).


RESULTS
For patients surviving to discharge, the median duration of the intensive care unit stay was 3 days (1-67), and the median duration of the post-operative hospital stay was 37 days (16-144). Mortality for the entire series was 6% at 30 days and 10% at 90 days. The main causes of post-operative inpatient death were primary graft failure (41%), sepsis (29%), cardiac (15%), and hemorrhage (9%). The 1-, 3-, 5-, and 10-year actuarial survival rates for the entire series was 81%, 68%, 63%, and 36%, respectively. There were no significant differences in survival between types of transplant. No significant differences in survival were seen between alpha(1)AT deficiency and COPD patients after stratifying for age. Cox regression analysis demonstrated that age 60 years or older, donor age 50 years or older, and a recipient pre-operative body mass index of 25 or higher were independent predictors of poor survival.


CONCLUSIONS
This center has 1-, 3-, and 5-year survival rates comparable to other high volume centers. Recipient age, pre-operative body mass index, and donor age significantly influence outcome after lung transplantation.
Burton
Christopher M
CM
Division of Lung Transplantation, Department of Medicine, Hjertecentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. cmburton@doctors.net.uk
Milman
Nils
N
Carlsen
Jørn
J
Arendrup
Henrik
H
Eliasen
Kirsten
K
Andersen
Claus B
CB
Iversen
Martin
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D019072:Antibiotic Prophylaxis; D015992:Body Mass Index; D003718:Denmark / Q000453:epidemiology; D004541:Eisenmenger Complex / Q000601:surgery; D005260:Female; D016041:Heart-Lung Transplantation / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D007902:Length of Stay; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000601:surgery; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000601:surgery; D016019:Survival Analysis; D019896:alpha 1-Antitrypsin Deficiency / Q000601:surgery