Heart-lung transplantation at stanford university since 1981

T. Deuse, S. Schrepfer, R. Sista, F. Haddad, D. Weill, G. Dhillon, D. Tang, H. Mallidi, S. Hunt, P. Oyer, R. Robbins, B. Reitz

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Long-term survival after heart-lung transplantation (HLTx) was first achieved in 1981 at Stanford. This is the longest retrospective single-center study summarizing our 27-year experience. Methods and Materials: Medical records of all HLTx performed at Stanford between 3/1981 and 6/2008 were reviewed. Results: A total of 217 HLTx were performed in 212 patients with a mean age of 31.2±12.1 years, ranging between 49 days and 58 years. Overall 1- and 10-year survival started at 62.1% and 17.2% in 1981-1985, and improved to 100% and 41.2%, respectively, in recent years. Median survival was similar for the three most common diagnoses congenital disease (6.5 years), primary pulmonary hypertension (4.3 years), and cystic fibrosis (5.9 years), p=0.464. Only 23.7%, 29.0%, and 31.6% of all patients did not experience cellular rejection in the 1980s, 1990s, and 2000s, respectively. Freedom from infection was only 8.2% after 1 year and 0% by 5 years. Freedom from bronchiolitis obliterans syndrome (BOS) was 96.4%, 66.7%, and 50.2%, and freedom from graft vasculopathy was 99.3%, 94.1%, and 65.8% after 1, 5, and 10 years, respectively. Less than 20% of the patients developed posttransplant malignancy within the first 10 years, but the rate doubled to 40% after 15 years. Infection (48.1%) and obliterative bronchiolitis (38.2%) were the main cause of death within 1 year and between 5 and 10 years, respectively. Of 153 patients transplanted between 3/1981 and 6/1998, 46 (30.1%) survived >10 years and 78 (51.0%) survived <5 years. Comparing these groups, 10-year survivors had significantly fewer CMV D+/R- combinations (20.0% vs. 33.3%) and experienced significantly fewer rejection episodes within the first year (0.9±1.0 vs. 1.5±1.0, p=0.005). Eight patients lived longer than 20 years.None of these patients had prior chest surgery. Only 0.5±0.6 rejection episodes were reported in this patient population. Conclusions: Huge improvements have been achieved over the last 27 years. However, strategies to control BOS will be needed in order to achieve routine longterm survival.

Original languageEnglish (US)
Pages (from-to)23
Number of pages1
JournalTransplantationsmedizin: Organ der Deutschen Transplantationsgesellschaft
Volume21
Issue numberSUPPL. 2
StatePublished - 2009

ASJC Scopus subject areas

  • Transplantation

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