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J Thorac Cardiovasc Surg 2005;129:1421-1429
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Primary graft dysfunction and other selected complications of lung transplantation: A single-center experience of 983 patients

Bryan F. Meyers, MDa,*, Maite de la Morena, MDc, Stuart C. Sweet, MDc, Elbert P. Trulock, MDb, Tracey J. Guthrie, RN, BSNa, Eric N. Mendeloff, MDa, Charles Huddleston, MDa, Joel D. Cooper, MDa, G. Alexander Patterson, MDa

a Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
b Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine; the Department of Pediatrics; Washington University School of Medicine, St Louis, Mo
c Jacqueline Maritz Lung Center at Barnes-Jewish Hospital, St Louis Children’s Hospital, St Louis, Mo.

Received for publication April 22, 2004; revisions received December 15, 2004; accepted for publication January 13, 2005.

* Address for reprints: Bryan F. Meyers, MD, One Barnes-Jewish Plaza, 3108 Queeny Tower, St Louis, MO 63110. (Email: meyersb{at}wustl.edu).

OBJECTIVES: We sought to review the incidence and outcome of lung transplantation complications observed over 15 years at a single center.

METHODS: We performed a retrospective review from our databases, tracking outcomes after adult and pediatric lung transplantation. The 983 operations between July 1988 and September 2003 included 277 pediatric and 706 adult recipients. Bilateral (74%), unilateral (19%), and living lobar transplants (4%) comprised the bulk of this experience. Retransplantations accounted for 44 (4.5%) of the operations.

RESULTS: The groups differed by indication for transplantation. The adults included 57% with emphysema and 17% with cystic fibrosis, and the children included no patients with emphysema and 50% with cystic fibrosis. Hospital mortality was 96 (9.8%) of 983, including 46 (17%) of 277 of the children and 50 (7%) of 706 of the adults. The overall survival curves did not differ between adults and children (P = .56). Freedom from bronchiolitis obliterans syndrome at 5 and 10 years was 45% and 18% for adults and 48% and 30% for children, respectively (P = .53). The causes of death for adults included bronchiolitis obliterans syndrome (40%), respiratory failure (17%), and infection (14%), whereas the causes of death in children included bronchiolitis obliterans syndrome (35%), infection (28%), and respiratory failure (21%) (P < .01). Posttransplantation lymphoproliferative disease occurred in 12% of pediatric recipients and 6% of adults (P < .01). The frequency of treated airway complications did not differ between adults and children (9% vs 11%, P = .48). The frequency of primary graft dysfunction did not differ between children (22%) and adults (23%), despite disparity in the use of cardiopulmonary bypass.

CONCLUSION: These results highlight major complications after lung transplantation. Despite differences in underlying diagnoses and operative techniques, the 2 cohorts of patients experienced remarkably similar outcomes.




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