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Thorax 63:725-731 doi:10.1136/thx.2007.092056
  • Cystic fibrosis

Outcomes of lung transplantation for cystic fibrosis in a large UK cohort

  1. G Meachery1,
  2. A De Soyza2,
  3. A Nicholson3,
  4. G Parry1,
  5. A Hasan1,
  6. K Tocewicz1,
  7. T Pillay1,
  8. S Clark1,
  9. J L Lordan1,2,
  10. S Schueler1,
  11. A J Fisher1,2,
  12. J H Dark1,
  13. F K Gould3,
  14. P A Corris1,2
  1. 1
    Department of Cardiopulmonary Transplantation, The Freeman Hospital, High Heaton, Newcastle-upon-Tyne, UK
  2. 2
    Applied Immunobiology and Transplantation, Institute of Cellular Medicine, University of Newcastle, UK
  3. 3
    Department of Medical Microbiology, The Freeman Hospital, High Heaton, Newcastle-upon-Tyne, UK
  1. Dr A De Soyza, Applied Immunobiology and Transplantation, Institute of Cellular Medicine, University of Newcastle, Newcastle-upon-Tyne NE7 7DN, UK; anthony.de-soyza{at}ncl.ac.uk
  • Received 31 October 2007
  • Accepted 26 March 2008
  • Published Online First 16 May 2008

Abstract

Background: Lung transplantation is an important option to treat patients with advanced cystic fibrosis (CF) lung disease. The outcomes of a large UK cohort of CF lung transplantation recipients is reported.

Methods: Retrospective review of case notes and transplantation databases.

Results: 176 patients with CF underwent lung transplantation at our centre. The majority (168) had bilateral sequential lung transplantation. Median age at transplantation was 26 years. Diabetes was common pretransplantation (40%). Polymicrobial infection was common in individual recipients. A diverse range of pathogens were encountered, including the Burkholderia cepacia complex (BCC). The bronchial anastomotic complication rate was 2%. Pulmonary function (forced expiratory volume in 1 s % predicted) improved from a pretransplantation median of 0.8 l (21% predicted) to 2.95 l (78% predicted) at 1 year following transplantation. We noted an acute rejection rate of 41% within the first month. Our survival values were 82% survival at 1 year, 70% at 3 years, 62% at 5 years and 51% at 10 years. Patients with BCC infection had poorer outcomes and represented the majority of those who had a septic death. Data are presented on those free from these infections. Bronchiolitis obliterans syndrome (BOS) and sepsis were common causes of death. Freedom from BOS was 74% at 5 years and 38% at 10 years. Biochemical evidence of renal dysfunction was common although renal replacement was infrequently required (<5%).

Conclusion: Lung transplantation is an important therapeutic option in patients with CF even in those with more complex microbiology. Good functional outcomes are noted although transplantation associated morbidities accrue with time.

Footnotes

  • See Editorial, page 668, and page 732

  • Funding: ADS was supported by a HEFCE Senior Lectuereship.

  • Competing interests: None.