Lung and heart-lung transplantation for end-stage lung disease

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Abstract
Between February 1988 and December 1989, 15 combined heart-lung, 2double lung and 5 single lung transplants were performed at our institutionfor end stage lung disease. The indication for heart-lung transplantationwas primary lung disease with associated secondary heart failure in 11cases, diffuse pulmonary disease with extensive adenopathy of the hilum in2 cases and profuse and antibiotic-resistant tracheobronchial infection dueto Pseudomonas in 2 cases. A double lung transplant was performed in 2patients with hypertensive emphysema. The indication for a single lungtransplantation was emphysema in 2 cases and pulmonary fibrosis in 3 cases;in this last indication, transplantation should be performed on the rightside with a slight lengthening of the main bronchus to avoid theside-effects of mediastinal shift. There were 2 early deaths, 7 secondarydeaths (from the 2nd to the 5th month) due to viral or bacterial infectiouscomplications, and 1 late death in the 7th month (infection due to asyncitial virus). All 12 surviving patients have an excellent functionalresult; the size of the tracheal or bronchial anastomosis ranges from 85%to 100% of normal. From this experience, we conclude that specificity andseverity of lung hazards are mainly related to bronchial infection,dependence on steroids and pleural adhesions. Moreover, posttransplantpulmonary oedema, mucociliary dysfunction and the differential diagnosisbetween rejection and infection require careful endobronchial suction andperiodical sampling.

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