University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Objective : Lung transplantation (LTx) has become an accepted treatment modality for very well selected patients suffering from a variety of end-stage lung diseases. Results after this type of transplantation may be well related to the volume of the programme and the experience of the whole transplant team. The purpose of this study was to review our results with isolated LTx over the past 10 years and to analyze the possible changes that have occurred during this period.
Methods : Between July 1991 until June 2001, 135 transplantations (heart-lung: n=26; isolated lung: n=109) have been performed in our institution. For the purpose of the present study, 100 consecutive isolated LTx were reviewed. The number of procedures have increased over the years (July '91 - June '96: n=39; July '96 - June '01: n=70). There were 63 male patients versus 37 female patients with a mean age (± SD) of 47 ± 11 years (15-66 years). Single lung transplantation (SLTx) was performed in 54 patients and bilateral lung transplantation (BLTx) in 46 patients (clam shell: n=42, bilateral anterior thoracotomies: n=4). The indications for LTx were smoking-induced emphysema (n=38), idiopathic pulmonary fibrosis (n=17), cystic fibrosis (n=16), alpha 1 ATD emphysema (n=13), sarcoidosis (n=4), histiocytosis X (n=3), primary pulmonary hypertension (n=3), re-transplantation for chronic graft failure (n=2), hemosiderosis (n=1), idiopathic obliterative bronchiolitis (n=1), bronchiectasis (n=1), and Kartagener syndrome (n=1). The patients were devided into 2 groups and the results were compared (group A: n° 1 - n° 50; group B: n° 51 - n° 100).
Results : The mean waiting time for a suitable organ was 158 ± 162 days (1-768 days). It was 186 ± 179 days in group A versus 130 ± 140 days in group B (p = 0.08) and 132 ± 123 days in SLTx versus 188 ± 196 days in BLTx (p = 0.08). The ratio of BLTx/SLTx has increased significantly over the years (14/36 in group A versus 32/18 in group B; p < 0.001). The mean ischemic time was 260 ± 58 min in SLTx, 304 ± 79 min for the first lung and 399 ± 50 min for the second lung in BLTx. The operative mortality was 2% in each group. The hospital mortality was 18% in group A versus 8% in group B (p = 0.23). This has further dropped to 4% (1/24) since January 2000. Long-term survival in both groups is compared in table (p < 0.05).
| Group | 6 months |
1 year |
2 years |
3 years |
4 years |
5 years |
9 years |
| A (n°1-n°50) | 68 % |
62 % |
44 % |
42 % |
36 % |
36 % |
18 % |
| B (n°51-n°100) | 88 % |
88 % |
67 % |
60 % |
NA |
NA |
NA |
Conclusions : Outcome after LTx in our center has improved over the years. This may be well correlated with a better individual choice of the transplant type (BLTx versus SLTx) and with the increasing experience of the whole transplant team. The number of procedures performed annually in one center may be an important parameter for the final outcome. Lung transplantation in Belgium, therefore, should be restricted to a small number of centers.