Are heart-lung transplant recipients protected from developing bronchiolitis obliterans syndrome?
BACKGROUND
Heart-lung transplant recipients, when compared with heart transplant recipients, are relatively spared from allograft coronary artery disease. This study was undertaken to investigate whether heart-lung transplant recipients are also spared from experiencing bronchiolitis obliterans syndrome (BOS) when compared with double-lung transplant recipients. In addition, the risk factors for developing BOS after lung transplantation were analyzed.


METHODS
Heart-lung and bilateral sequential double-lung transplant recipients were reviewed retrospectively from 1990 to 2000 using the Stanford Transplant Database. The heart-lung transplant group consisted of 77 heart-lung transplant recipients and the double-lung transplant group consisted of 51 double-lung transplant recipients. The rates of BOS, survival, acute rejection, and cytomegalovirus infection at 1, 3, and 5 years were measured.


RESULTS
There were no significant differences in patient demographics between the two groups. Rates of survival and acute rejection were similar in the two transplant groups. The incidence of cytomegalovirus infection was significantly higher in heart-lung transplant recipients. Freedom from BOS was similar in the two transplant groups. Risk factors for the development of BOS in the heart-lung and double-lung transplant recipients included male donor, younger recipient age, a diagnosis other than cystic fibrosis, nonuse of cardiopulmonary bypass, and the use of OKT3 induction therapy.


CONCLUSIONS
Heart-lung transplant recipients exhibit BOS at a rate similar to double-lung transplant recipients. The immunoprotective effect the lung allograft presumably provides the heart is not reciprocated by the heart in preventing the development of BOS.
Moffatt-Bruce
Susan D
SD
Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA.
Karamichalis
John
J
Robbins
Robert C
RC
Whyte
Richard I
RI
Theodore
James
J
Reitz
Bruce A
BA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D001989:Bronchiolitis Obliterans / Q000453:epidemiology* / Q000517:prevention & control; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate
D007166:Immunosuppressive Agents