(HEART-) lung transplantation in belgium

D. Van Raemdonck1, Ph. de Francquen2, P. Evrard3, P. Van Schil4, J.-O. Defraigne5, W. Tack6, G. Verleden1, M. Estenne2, J.-C. Schoevaerdts3, D. Van Ranst4, J. Vanhaecke1, W. Daenen1, J.-L. Vachiery2, M. Antoine2 1Universitair Ziekenhuis Gasthuisberg, Leuven (KUL); 2Hôpital Erasme, Bruxelles (ULB) ; 3Cliniques Universitaires UCL, Mont Godinne (UCL) ; 4Universitair Ziekenhuis Antwerpen, Edegem (UA); 5Centres Hospitaliers Universitaires Sart Tilman, Liège (ULg); 6Transplant Coorinator, OLV-Ziekenhuis, Aalst.

Background: Over the last 20 years, lung transplantation (LTx) has become the mainstay of therapy for selected patients suffering from different types of end-stage lung diseases. This form of surgical treatment has enjoyed increasing success worldwide. Belgium belongs to the pioneering countries in the field of lung transplantation with the first single lung transplantation performed by the group of Prof F. Derom (UZG) on 14/11/1968 and the first heart-lung transplantation performed by the team of Prof G. Primo (ULB) on 24/08/1983. Since the early nineties, nearly all Belgian University Hospitals have embarked on LTx.

Objective: The purpose of this study was to summarize the Belgian experience with this type of treatment over a 20-year period.

Methods: A simple questionnaire was sent by the first author to all LTx representatives in the Cardio-Pulmonary Committee of the Belgian Transplantation Society (CPC-BTS) (www.transplant.be). All LTx centers (100%) returned the questionnaire. Data for patients transplanted between 1 January 1983 and 31 December 2002 were analyzed.

Results: Over a period of 20 years, 434 (heart-)lung transplantations have been performed in 426 recipients at 5 University Hospitals (ULB: n=188, KUL: n=183, UCL: n = 56, UA: n=5, ULg: n=2). Eight patients (1.8%) underwent a second transplant for late graft failure resulting from chronic rejection and obliterative bronchiolitis (6 single lungs and 2 double lungs). The number of LTx per year is listed in Table. Heart-lung transplantation is performed in two centers only (ULB and KUL). There were 150 single lung (SL) transplants, 161 double lung (DL) transplants, and 123 heart-lung (HL) transplants. The type of LTx differed in frequency amongst all 5 LTx centers (ULB: 24%, 26%, 50%; KUL: 40%, 44%, 16%; UCL; 46%, 54%, 0%; UA: 60%, 40%, 0%; Ulg: 100%, 0%, 0% for SL, DL, and HL; respectively). The total number of HL transplants performed in ULB has dropped from 15 in 1995 to 3 in 2002 in favor of DL, mainly for cystic fibrosis patients. The indications for LTx were smoking-induced emphysema (n=102), cystic fibrosis (n=90), primary pulmonary hypertension (n=64), idiopathic pulmonary fibrosis (n=49), Eisenmenger's syndrome (n=37), a 1 antitrypsine deficiency emphysema (n=26), bronchiectasis (n=17), lymphangioleiomyomatosis (n=12), sarcoidosis (n=10), histiocytosis-X (n=8), re-transplantation for chronic graft failure (n=8), bronchiolo-alveolar cell carcinoma (n=3), chronic pulmonary emboli (n=2), anthracosilicosis (n=2), hemosiderosis (n=1), Williams-Campbell Syndrome (n=1), Kartagener Syndrome (n=1), and unknown (n=1). The indication for LTx also differed in frequency amongst the three major centers: (ULB: 14%, 31%, 9%, 19%, 10%, 17%; KUL: 42%, 14%, 14%, 10%, 9%, 11%; UCL: 41%, 11%, 9%, 16%, 4%, 19% for emphysema, cystic fibrosis, pulmonary fibrosis, primary pulmonary hypertension, Eisenmenger's syndrome, and other indications; respectively).
On 01-01-2003, 52 patients were on the waiting list in 4 active transplant centers: (KUL: n=29; ULB: n=16; UCL: n=7; UA: n=0).

Year	1983	1984	1985	1986	1987	1988	1989	1990	1991	1992
Number	1	2	/	/	2	4	6	8	21	30
Year	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002
Number	24	27	35	29	35	38	33	43	47	49

Conclusions: LTx in Belgium is currently performed in 4 centers (2 FL - 2 FR). The number of transplants has gradually increased over the last decade reaching nearly 50 transplants per year (±1 LTx per 200.000 inhabitants yearly). The type of LTx as well as the indication for LTx differed amongst the centers. Regular meetings in the CPC-BTS to discuss indications and waiting list problems may result in a better cooperation and organ exchange amongst different LTx centers that will mostly benefit the Belgian recipients on the lung waiting list(s).