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Eur J Cardiothorac Surg 1998;14:191-196
© 1998 Elsevier Science NL

Lung transplantation for cystic fibrosis – a single center experience over 8 years¹

^a Division of Thoracic and Cardiovascular Surgery, Hannover Medical School (Medizinische Hochschule Hannover), 30623 Hannover, Germany
^b Division of Pulmonary Medicine, Hannover Medical School (Medizinische Hochschule Hannover), 30623 Hannover, Germany
^c Division of Pediatric Pulmonary Medicine, Hannover Medical School (Medizinische Hochschule Hannover), 30623 Hannover, Germany

Received 18 November 1997; received in revised form 7 May 1998; accepted 12 May 1998.

Corresponding author. HTG-Chirurgie, Medizinische Hochschule Hannover, 30623 Hannover, Germany. Tel.: +49 511 5326580; fax: +49 511 5325404.

Objective: Colonization of the lung and mediastinal lymphnodes with multi-resistent bacteria, diabetes and malnutrition represent potential risk factors for lung transplantation in cystic fibrosis. We therefore reviewed our experience in this patient population. Methods: Between December 1988 and March 1997, 219 lung and heart–lung transplantations were performed at our institution. Of these, 39 procedures were done in 35 patients with cystic fibrosis. All candidates (mean age 26 years) were oxygen dependent (preoperative mean PO₂: 44.8±9.1 Torr, preoperative mean PCO₂: 53.4±10.5 Torr, one patient on respirator). Of the primary operations, 34 were performed as bilateral sequential lung transplants, one as a heart–lung transplantation. Results: Mean duration on respirator for survivors was 3.1 (1–12) days, mean ICU and hospital stay were 4.7 (1–13) and 28 (12–79) days, respectively. The 3-month mortality rate was 5.7% (two patients died due to acute graft failure on days 36 and 73). Other causes of death in the follow-up were cerebral bleeding (one patient) and chronic graft failure (three patients). The survival rates were 91% at 1 year, 83% at 3 years and 76% at 5 years. In eight patients, a bronchiolitis obliterans syndrome (BOS) developed (in four cases grade 3). The freedom of BOS (grade 1 or more) at 1, 3 and 5 years was 87, 79 and 55%, respectively. Four retransplantations were performed. Of the 29 patients alive, only seven are physically limited. Conclusion: Bilateral lung transplantation for cystic fibrosis allows for acceptable early- and long-term results. Postoperative survival is not impaired by infection, diabetes and malnutrition. Long-term functional outcome seems to be comparable to lung transplantation in patients without infectious pulmonary disease.

Key Words: Lung transplantation • Cystic fibrosis

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