Outcomes of lung transplantation for cystic fibrosis in a large UK cohort
- G Meachery1,
- A De Soyza2,
- A Nicholson3,
- G Parry1,
- A Hasan1,
- K Tocewicz1,
- T Pillay1,
- S Clark1,
- J L Lordan1,2,
- S Schueler1,
- A J Fisher1,2,
- J H Dark1,
- F K Gould3,
- P A Corris1,2
- 1Department of Cardiopulmonary Transplantation, The Freeman Hospital, High Heaton, Newcastle-upon-Tyne, UK
- 2Applied Immunobiology and Transplantation, Institute of Cellular Medicine, University of Newcastle, UK
- 3Department of Medical Microbiology, The Freeman Hospital, High Heaton, Newcastle-upon-Tyne, UK
- 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.
