title: Short- and long-term outcomes of 1000 adult lung transplant recipients at a single center.
abstract: OBJECTIVE
  Lung transplantation has become accepted therapy for end-stage pulmonary disease. The objective of this study was to review a single-institution experience of adult lung transplants.
  
  
  METHODS
  We reviewed 1000 adult lung transplants that were performed at Washington University between July 1988 and January 2009.
  
  
  RESULTS
  Transplants were performed for emphysema (52%), cystic fibrosis (18.2%), pulmonary fibrosis (16.1%), and pulmonary vascular disease (7.2%). Overall recipient age was 48 ± 13 years with an increase from 43 ± 12 years (July 1988-November 1993) to 50 ± 14 years (June 2005-January 2009). Overall incidence of primary graft dysfunction was 22.1%. Hospital mortality was higher for patients who had primary graft dysfunction (primary graft dysfunction, 13.6%; no primary graft dysfunction, 4%; P < .001). Freedom from bronchiolitis obliterans syndrome was 84% at 1 year, 38.2% at 5 years, and 12.2% at 10 years. Survival at 1, 5, 10, and 15 years was 84%, 56.4%, 32.2%, and 17.8%, respectively. Five-year survival improved from 49.6% (July 1988-November 1993) to 62.1% (October 2001-June 2005). Primary graft dysfunction was associated with lower survival at 1, 5, and 10 years (primary graft dysfunction: 72.8%, 43.9%, and 18.7%, respectively; no primary graft dysfunction: 87.1%, 59.8%, and 35.7%, respectively, P < .001) and lower rates of freedom from bronchiolitis obliterans syndrome (primary graft dysfunction: 78%, 27.5%, and 8.5%, respectively; no primary graft dysfunction: 85.4%, 40.7%, and 13.1%, respectively, P = .007).
  
  
  CONCLUSIONS
  Five-year survival has improved over the study period, but long-term outcomes are limited by bronchiolitis obliterans syndrome. Primary graft dysfunction is associated with higher rates of bronchiolitis obliterans syndrome and impaired short- and long-term survival. A better understanding of primary graft dysfunction and bronchiolitis obliterans syndrome is critical to improve outcomes.
authors.affiliation: The Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Mo 63110-1013, USA. kreiseld@wudosis.wustl.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Krupnick
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Guthrie
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008923:Missouri; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome