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Lung transplantation for chronic obstructive pulmonary disease at St Vincent's Hospital
Author(s) -
Güneş A.,
Aboyoun C. L.,
Morton J. M.,
Plit M.,
Malouf M. A.,
Glanville A. R.
Publication year - 2006
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2006.01003.x
Subject(s) - medicine , interquartile range , copd , perioperative , lung transplantation , vital capacity , surgery , transplantation , lung , diffusing capacity , lung function
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, PaCO 2 , PaO 2 , 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.