Advances in lung transplantation for cystic fibrosis that may improve outcome.
OBJECTIVE
To study the advances in the management of lung-transplanted patients for cystic fibrosis in our centre and their impact on the outcome.


METHODS
A retrospective study has included 100 patients who underwent lung transplantation for cystic fibrosis between 1 January 1990 and 15 January 2007. There were 78 sequential double-lung transplantations and 22 lobar transplantations. This series has been equally divided in two groups according to the date of transplantation: group I, before September 2003 and, group II, after September 2003.


RESULTS
Recipient characteristics were similar in both groups. In group II, donors were older (40 vs 33 years, respectively, P=0.013), with lower partial pressure of oxygen in arterial blood (PaO(2))/fractional inspired oxygen (FiO(2)) ratios (372 vs 427 mmHg, P=0.022). In group II, recipients received, more often, thoracic epidural analgesia (n=35 vs n=13, P<0.001), the surgical approach was mostly a sternum-sparing bilateral anterior thoracotomy (n=42 vs n=9, P<0.001), and lobar transplantations were performed more frequently (n=15 vs n=7, P=0.30). Early tracheal extubation was more frequent in group II (P=0.005). The overall median survival time was 52 months. In the first group, 1-, 2- and 3-year survival rates were 75%, 65% and 55%, respectively, whereas in the second group, these survival rates were 88%, 78% and 69%, respectively (P=0.09).


CONCLUSIONS
The acceptance of marginal donors and the frequent practice of lobar transplantations allowed an increasing number of lung transplantations for cystic fibrosis over time. Concomitantly, the extensive use of thoracic epidural analgesia has increased the rate of early extubation and contributed to a trend towards a survival improvement.
Mordant
Pierre
P
Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, 40 rue Worth, 92151 Suresnes, France.
Bonnette
Pierre
P
Puyo
Philippe
P
Sage
Edouard
E
Grenet
Dominique
D
Stern
Marc
M
Fischler
Marc
M
Chapelier
Alain
A
D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods / Q000639:trends; D003550:Cystic Fibrosis / Q000601:surgery*; D046148:Donor Selection / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D018579:Patient Selection; D016896:Treatment Outcome; D055815:Young Adult
D010100:Oxygen