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Lung transplantation for chronic obstructive pulmonary disease at St Vincent's Hospital

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Abstract:

Abstract Background:

Lung transplantation (LTx) offers selected patients with end-stage chronic obstructive pulmonary disease (COPD) an improved quality of life and possibly enhanced survival. Aim:

To determine local outcomes of LTx for COPD we analysed 173 consecutive heart–LTx (n = 8), single LTx (SLTx; n = 99) and bilateral LTx (BLTx; n = 66) carried out at a single institution during 1989–2003 for smoking-related emphysema (E) (n = 112) and emphysema related to α-1 antitrypsin deficiency (AATD) (n = 61). Methods:

There were 98 men and 75 women with a mean age of 50 ± 6 years (standard deviation) (range 32–63 years). Median waiting time was 113 days (interquartile range (IQR) 50–230 days), and median inpatient stay was 13 days (IQR 9–21 days). Results:

Perioperative survival (30 days) was 95% with deaths from sepsis (n = 5), cerebrovascular accident (n = 3) and multiorgan failure (n = 1). Mean follow-up period was 1693 ± 1302 days (2–4805 days). The 1-, 5- and 10-year survivals (%) were similar for patients with E and AATD (P = 0.480 log rank) at 86 ± 5, 57 ± 7 and 31 ± 11, respectively, but 1- and 5-year survivals for E were higher after BLTx than after SLTx (97 ± 2 and 81 ± 8 vs 85 ± 4 and 47 ± 6) (P = 0.015). Pretransplant body mass index, forced expiratory volume in 1 second, forced vital capacity, PaCO2, PaO2, six-minute walk distance, home oxygen use, age, sex, cytomegalovirus donor–recipient mismatch, cardiopulmonary bypass use, year of transplant and ischaemic time did not influence survival after LTx. Increasing donor age was a survival risk factor for patients with E but not for those with AATD (hazard ratio 1.043; 95%confidence interval 1.014–1.025). Conclusion:

Survival after LTx for COPD is similar to survival for other forms of solid organ transplantation, in part reflecting risk factor management.

Keywords: COPD; lung transplant

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2006.01003.x

Affiliations: 1: Thoracic Medicine, Cairns Base Hospital, Cairns, Queensland 2: Lung Transplant Unit, St Vincent's Hospital, Sydney, New South Wales 3: Respiratory Medicine, Monash Medical Centre, Melbourne, Victoria, Australia

Publication date: January 1, 2006

bsc/imj/2006/00000036/00000001/art00003
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