Lung transplantation: the Cleveland Clinic experience
Sunit R. Patel, MD
Thomas J. Kirby, MD
Patrick M. McCarthy
David P. Meeker, MD
Paul Stillwell, MD
Thomas W. Rice, MD
Mani S. Kavuru, MD
Atul C. Mehta, MDAddress reprint requests to A.C.M., Department of Pulmonary and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Lung transplantation has been steadily developing as a therapeutic option for end-stage lung disease.METHODS
Retrospective analysis of all 26 patients who underwent lung transplantation at the Cleveland Clinic Foundation between February 1990 and February 1992.RESULTS
Nineteen single-lung transplantations and seven bilateral lung transplantations were performed. The 1-year actuarial survival for all recipients was 65%. A trend was noted towards better survival in recipients with emphysema (100%) and poorer survival in those with pulmonary hypertension (37.5%). Fungal sepsis and reimplantation lung injury were the most common causes of death, and most deaths (8 of 9) occurred within the first 4 weeks. Of 119 pulmonary complications, 82% occurred in the first 3 months, with infection (39%) and acute rejection (29%) being the most common. Bacterial and fungal infections occurred mainly in the first month, and cytomegalovirus infections occurred mainly in the second and third months. The majority of survivors have shown improvement in functional status.CONCLUSIONS
The early perioperative and 1-month post-transplantation period appears critical to long-term survival. Even though the complications are numerous, they are usually manageable and, in general, do not result in long-term morbidity.