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| Single Center Experience of 1000 Adult Lung Transplants |
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Daniel Kreisel1, Sasha A. Krupnick1, Varun Puri1, Tracey J. Guthrie1, Elbert Trulock2, Bryan Meyers1, Alec Patterson1; 1Surgery, Washington University in St. Louis, St. Louis, MO; 2Medicine, Washington University in St. Louis, St. Louis, MO Objective: Lung transplantation has become accepted therapy for end stage pulmonary disease. The objective of this study was to review a single institution experience of adult lung transplants. Methods: We reviewed 1000 adult lung transplants that were performed at a single center between 7/1988 and 1/2009. Results: Indications for transplantation were emphysema in 52% of recipients, cystic fibrosis in 18.2%, pulmonary fibrosis in 16.1% and pulmonary vascular disease in 7.2%. There was a decrease in transplants for emphysema (54% from 7/88-11/93 vs. 39.5% from 6/05-1/09) and vascular disease (14.5% vs. 1.5%) and an increase for fibrosis (9.5% vs. 31.5%). Overall recipient age was 48±13 years with an increase from 43±12 (7/88-11/93) to 50±14 years (6/05-1/09). We performed bilateral transplants in 80.5% and single transplants in 18.6% of recipients. Lengths of ICU and hospital stays were 3 and 15 days, respectively. Overall incidence of primary graft dysfunction (PGD) was 22.1%. There was no decline in the incidence of PGD during the study period (23% for patients transplanted between 7/88-11/93 and 23.5% for transplants between 6/05-1/09). Overall hospital mortality was 6.1%. Hospital mortality was significantly higher for patients, who suffered from PGD compared to those, who did not experience PGD (13.6% vs. 4%, p<0.001). 20 patients (2%) required retransplantation for PGD (11) or bronchiolitis obliterans (BO) (9). Freedom from BO syndrome was 84% at 1 year, 38.2% at 5 years and 12.2% at 10 years after transplantation. Freedom from BO syndrome at 5 years has improved from 24.3% for transplants performed between 7/88 and 11/93 to 43.5% for patients transplanted between 10/01 and 6/05. 1-, 5-, 10- and 15-year survival rates were 84%, 56.4%, 32.2% and 17.8%, respectively. 5-year survival rates improved from 49.6% for patients transplanted between 7/88 and 11/93 to 62.1% for transplants between 10/01 and 6/05. Notably, PGD was associated with lower survival rates at 1, 5 and 10 years (PGD: 72.8%, 43.9%, 18.7% vs. No PGD: 87.1%, 59.8%, 35.7%, p<0.001) and lower rates of freedom from BO syndrome (PGD: 78%, 27.5%, 8.5% vs. No PGD: 85.4%, 40.7%, 13.1%, p=0.007). Conclusion: While 5-year survival rates have improved over the study period, long term outcomes continue to be limited by the development of BO. PGD is associated with higher rates of BO syndrome and impaired short and long term survival. A better understanding of PGD and BO are critical to improve outcomes after lung transplantation. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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