Lung transplantation survival

Smith MA, Sundaresan S, Mohanakumar T, Trulock EP, Lynch JP, Phelan DL, Cooper JD, Patterson GA. Effect ofdevelopment of antibodies to HLAand cytomegalovirus mismatch on lung transplantation survival and development of bronchiohlis obliterans syndrome. J Thorac Cardiovasc Surg 1998 116(5) 812-820. 

Bullectomy, lung volume reduction surgery, and lung transplantation are surgical options for very severe COPD. These procedures may result in improved spirometry, lung volumes, exercise capacity, dyspnea, health-related quality of life, and possibly survival. Patient selection is critical because not all patients benefit. Refer to the ATS/ERS COPD standards for a detailed discussion of appropriate selection of surgical candidates.1... 

Cyclosporine has been approved for use in allogeneic kidney, liver, and heart transplant patients and is under study for use in pancreas, bone marrow, single lung, and heart-lung transplant procedures. It is recommended that corticosteroids, such as prednisone, be used concomitantly, although at half or less of their usual dose. Such combined therapy leads to fewer side effects, a decreased incidence of infectious complications, efficacy of lower doses of cyclosporine, and a better history of patient survival. 

Sykes A. 2006. Inhaled cyclosporine may increase survival after lung transplantation. Thorax. 61 305-305. 

The first combined heart-lung transplant was performed in 1981 at Stanford University. Combined heart-lung donors need to satisfy both the requirements already described separately. Combined heart-lung transplant is recommended in patients with congenital problems affecting these organs, pulmonary hypertension and/or cystic fibrosis. The recipients for the combined transplant are recommended to be less than 55 years old. Survival rates are 79, 66, and 54% at 1 month, 1 year and 3 years, respectively, after transplantation. 

Lung transplantation has been used in the treatment of lung disease associated with ax-antitrypsin deficiency. Survival is the same as for patients undergoing the procedure for chronic obstructive pulmonary disease. As with any transplantation, lifelong immunosuppression is necessary. 

Barlow, C.W. Moon, M.R. Green, G.R. Gamberg, P. Theodore, J. Reitz, B.A. Robbins, R.C. Rabbit antilymphocyte globulin versus OKT3 induction therapy after heart-lung and lung transplantation effect on survival, rejection, infection, and obliterative bronchiolitis. Transplant Int. 2001, 14, 234-239. 

Currently, MMF is approved for use in kidney, liver, and heart transplants. A recent analysis of 5599 patients in the Joint International Society for Heart and Lung Transplantation (ISHLT) and UNOS Thoracic Registry showed a statistically signihcant survival advantage for MMF compared with azathioprine (1 year, 96% versus 93% 3 years, 91% versus 86%). Efficacy has been demonstrated in combination with both CSA and TAC. 

Currently, since the safety and efficacy of SRL has not been established in liver or lung transplants, it is recommended that its use be avoided in these populations immediately following transplant. In contrast, limited data on the use of SRL in heart transplantation indicate benefit in reversing acute rejection in patients who do not respond to antilymphocyte therapy. Furthermore, SRL may slow the progression of vasculopathy, which may have an impact on chronic rejection and long-term patient survival after heart transplantation. ... 

Hosenpud JD, Bennett LE. Mycophenolate mofetil compared to azathio-prine improves survival in patients surviving the initial cardiac transplant hospitalization An analyisis of the joint ISHLT/UNOS Thoracic Registry. J Heart Lung Transplant 2000 19 72. 

Alio- / xenogeneic transplantation graft rejection cyclosporine A, but not tacrolimus, has strong additive effect wilh calcitriol on acute rat lung allograft survival and xenogeneic islets in nonobese diabetic mice [148, 213]... 

Also, the decreased availability of -NO during the immediate reperfusion period appears to contribute to the elevated pulmonary resistance and neutrophil recruitment that occurs after lung transplantation. In support of this, augmentation of the -NO pathway enhances lung preservation for transplantation as well as posttransplant survival (Pinsky et al., 1994). 

During allograft acute rejection, the production of NO as measured nitrite/nitrate levels, has been demonstrated in several experimental models and inhibition of inducible nitric oxide synthase (rNOS) activity in a rat lung transplant model dramatically improved the survival rate of allografts (Shiraishi etal. 1995, Worrall etal. 1997). Studies carried out on transplant samples from patients with end-stage obliterative bronchioHfis have shown that in... 

Thabut G, Mai H et al. (2003) Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis. J Thorac Cardiovasc Surg 126 469-475... 

LT (either single or bilateral) is a viable option for patients with end-stage pulmonary sarcoidosis refractory to medical therapy (113,198-200). From January 1995 to June 2006, 438 adults worldwide had received lung transplants for sarcoidosis (201). Long-term survival rates following LT for sarcoidosis are generally similar to other indications (198). However, in a retrospective review of U.S. data from 1995 to 2000, 30-day survival post-LT was 83% among 133 patients with sarcoidosis compared to 91% with other conditions... 

LT is the best therapeutic option for patients with IPF with life-threatening disease (208-210). Since no medical therapies have been proven to influence survival in IPF, IPF patients should be referred to LT centers at the time of diagnosis (provided no contraindications exist). The decision to list for LT is best made by the local transplant team members, who are familiar with local waiting times. Either single (SLT) or bilateral sequential lung transplantation (BSLT) can be performed (208,209,211). Data from the International Society for Heart and Lung Transplantation (ISHLT) Registry reported that 19% of >17,000 LTs... 

Kawut SM, O Shea MK, Bartels MN, et al. Exercise testing determines survival in patients with diffuse parenchymal lung disease evaluated for lung transplantation. Respir Med 2005 99(11) 1431-1439. 

Meyer DM, Edwards LB, Torres F, et al. Impact of recipient age and procedure type on survival after lung transplantation for pulmonary fibrosis. Ann Thorac Surg 2005 79(3) 950-957 discussion 7-8. 

Whelan TP, Dunitz JM, Kelly RF, et al. Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis. J Heart Lung Transplant 2005 24(9) 1269-1274. 

Figure 1 Actuarial survival of lung transplantation only (excluding heart-lung transplantation) in the University hospital Leuven, Belgium according to two different time periods. The first period (from 1991 until December 2(XX>, n = 150) has a significantly inferior survival compared to the second period from January 2001 until June 2007 (n = 191).

In the recent ISHLT registry report, the one-, three-, and five-year prevalence rates of OB in adult lung transplant recipients (LTRs) followed-up between April 1994 and June 2005 were 10%, 30%, and 44%, respectively (1), whereas the one-, three- and five-year mortality rates from BOS were 5%, 26%, and 29%, respectively (1). OB/BOS is the single most important factor responsible for late mortality after lung transplantation, and affects 33% of LTRs who survive more than five years (1). 

Long-term survival after lung transplantation depends on the development and the severity of BOS (7). Further, OB/BOS also causes significant morbidity, loss of health-related quality of life (8,9), and constitutes a tremendous cost due to an increase in used health-care resources, in particular hospitalization and medication (10), further emphasizing the need to focus efforts on prevention of BOS to enhance the cost-effectiveness of LTx. 

Burton CM, Carlsen J, Mortensen J, et al. Long-term survival after lung transplantation depends on development and severity of bronchioUtis obliterans syndrome. J Heart Limg Transplant 2007 26 681-686. 

Bonatti H, Tabarelli W, Ruttmann E et al (2004) Impact of cytomegalovirus match on survival after cardiac and lung transplantation. Am Surg 70 710-714... 

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