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J Thorac Cardiovasc Surg 2003;125:20-22
© 2003 The American Association for Thoracic Surgery

Editorials

The ABCs of LTX for BAC

Thomas M. Egan, MD, MSc, Frank C. Detterbeck, MD

From the Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Received for publication Aug 26, 2002. Accepted for publication Sept 4, 2002. Address for reprints: Thomas M. Egan, MD, MSc, Division of Cardiothoracic Surgery, 108 Burnett-Womack Building, CB# 7065, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7065 (E-mail: ltxtme@med.unc.edu).

The first 300 words of the full text of this article appear below.

See related article on page 45.

Lung transplantation (LTX) is an effective form of palliative therapy for a variety of end-stage lung diseases, but access to LTX is severely limited by a scarcity of suitable donors. Fewer than 900 LTX procedures are performed annually in the United States although over 4000 patients are currently listed for LTX.Go 1 In part, because of the scarcity of donors, strict listing criteria for potential LTX recipients are espoused.Go 2 Current malignancy is considered an absolute contraindication to LTX, because of the concern that poor prognosis due to the malignancy and possible acceleration of tumor growth secondary to immunosuppression would surely jeopardize long-term survival. As deaths on the waiting list increase, there is growing pressure not to squander such a scarce and precious resource as transplantable lungs.

In this issue of the Journal, Zorn and associatesGo 3 challenge this paradigm by reporting their experience with LTX for a subset of patients with bronchioalveolar carcinoma (BAC). They tested the hypothesis that total lung replacement could be curative for the diffuse form of BAC by transplanting 9 patients presumed to have this diagnosis. One of the 9 was found to have adenocarcinoma, not BAC, after lung replacement, and so was not included in the Kaplan-Meier survival analysis. Arguably, by intention-to-treat analysis, this patient should have been included, because if LTX is to be recommended as a therapy for BAC, then this misdiagnosis would presumably occur with a similar frequency as it did in this report. This inclusion would not change the provocative finding that survival of patients with BAC who underwent LTX was similar to that of patients having LTX for other indications.

The fact that patients with BAC did just as well as patients with other indications for LTX is just as much a sad commentary on . . . [Full Text of this Article]


Related Article

Pulmonary transplantation for advanced bronchioloalveolar carcinoma
George L. Zorn, Jr, David C. McGiffin, K. Randall Young, Jr, C. Bruce Alexander, David Weill, and James K. Kirklin
J. Thorac. Cardiovasc. Surg. 2003 125: 45-48. [Abstract] [Full Text] [PDF]





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