Heart-lung transplantation at Papworth Hospital

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Abstract
Combined heart-lung transplantation has been performed in 51 patientssince 1984. A pulmonary preservation fluid preceded by prostacyclininfusion has allowed distant procurement. Early organ function has beengood in all cases. Maintenance immunosuppression is cyclosporine andazathioprine. Steroids are given to treat rejection episodes.Transbronchial biopsy has allowed the accurate, early and safe diagnosis ofrejection. Acute cardiac rejection has not occurred in these patients.Thirty-seven patients are alive between 1 and 54 months followingtransplantation. The actuarial survival at 1 year is 76% and 68% at 2years. Four patients died in the early postoperative period as a result ofprimary Cytomegalovirus (CMV). Other causes of early death were bacterialinfection (4), cerebrovascular event (1), tracheal dehiscence (1) and smallbowel infarction following retransplantation for obliterativebronchiolitis. Three other patients have died as a result of obliterativebronchiolitis. Patients and donors have been carefully selected to ensurethat this scarce resource is utilised most effectively.

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