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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 287-293, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JC Ramirez, GA Patterson, TL Winton, AL de Hoyos, JD Miller and JR Maurer
Between March 1988 and March 1991, 17 patients underwent bilateral lung
transplantation for end-stage lung disease caused by cystic fibrosis. There
were 11 male and six female patients. Ages ranged from 19 to 41 years (mean
age 28 years). Preoperative mean arterial oxygen tension with the patient
breathing room air was 54 +/- 6 mm Hg; forced vital capacity, 1.8 +/- 0.7
L; forced expiratory volume in 1 second, 0.9 +/- 0.3 L; and 6-minute walk
test, 506 +/- 44 m. Immunosuppression consisted of cyclosporine,
azathioprine, and prednisone. Induction immunosuppression was obtained with
Minnesota antilymphocyte globulin. All patients received perioperative
antibiotics according to sputum cultures and sensitivities. There were six
operative deaths, four of which resulted from bacterial infection. Two
patients required a second transplantation, one receiving a single lung and
one undergoing bilateral lung replacement. Significant functional
improvement was observed in all survivors. At 3 months follow-up, mean
arterial oxygen tension on room air was 95 +/- 6 mm Hg (p less than 0.01);
forced vital capacity, 3 +/- 0.8 L (p less than 0.01); forced expiratory
volume in 1 second, 2.6 +/- 0.9 L (p less than 0.01); and 6-minute walk
test, 678 +/- 47 m (p less than 0.01). The actuarial survival rate was 66%
at 3 months and 58% at 6, 12, and 24 months. The most frequent cause of
morbidity and mortality was acute pneumonia resulting from Pseudomonas
cepacia. For patients with respiratory failure caused by cystic fibrosis,
bilateral lung transplantation is an effective treatment option associated
with significant functional improvement.
ARTICLES
Bilateral lung transplantation for cystic fibrosis. The Toronto Lung Transplant Group
Department of Surgery, University of Toronto, Ontario, Canada.
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