The Copenhagen National Lung Transplant Group: Survival after Single Lung, Double Lung, and Heart-Lung Transplantation

doi:10.1016/j.healun.2005.03.001

The Journal of Heart and Lung Transplantation

Volume 24, Issue 11, November 2005, Pages 1834-1843

https://doi.org/10.1016/j.healun.2005.03.001 Get rights and content

Objective

To review the 13-year clinical experience of a single center’s adult lung transplantation program.

Methods

From January 1992 to December 2003, 369 lung transplantations were performed on 362 patients. Single lung transplantation was performed in 234 cases, double lung transplantation in 113 cases (comprising en-bloc double lung transplantation in 44 cases and bilateral sequential lung transplantation in 69 cases), heart-lung transplantation in 21 cases, and lobe of lung transplantation in 1 case. Recipient diagnoses included chronic obstructive pulmonary disease (COPD) (n = 175), α₁ antitrypsin (α₁AT) deficiency (n = 86), cystic fibrosis (n = 36), pulmonary fibrosis (n = 20), Eisenmenger syndrome and secondary pulmonary hypertension (n = 24), primary pulmonary hypertension (n = 8), sarcoidosis (n = 7), silicosis (n = 4), bronchiectasis (n = 1), and graft-vs-host disease (n = 1).

Results

For patients surviving to discharge, the median duration of the intensive care unit stay was 3 days (1–67), and the median duration of the post-operative hospital stay was 37 days (16–144). Mortality for the entire series was 6% at 30 days and 10% at 90 days. The main causes of post-operative inpatient death were primary graft failure (41%), sepsis (29%), cardiac (15%), and hemorrhage (9%). The 1-, 3-, 5-, and 10-year actuarial survival rates for the entire series was 81%, 68%, 63%, and 36%, respectively. There were no significant differences in survival between types of transplant. No significant differences in survival were seen between α₁AT deficiency and COPD patients after stratifying for age. Cox regression analysis demonstrated that age 60 years or older, donor age 50 years or older, and a recipient pre-operative body mass index of 25 or higher were independent predictors of poor survival.

Conclusions

This center has 1-, 3-, and 5-year survival rates comparable to other high volume centers. Recipient age, pre-operative body mass index, and donor age significantly influence outcome after lung transplantation.

Section snippets

Patients and methods

In Denmark, the first lung transplantation was performed in January 1992 at the National Heart and Lung Transplantation Center situated at the Copenhagen University Hospital, Rigshospitalet. All subsequent lung transplantations have been performed by this center. During the period 1992 to 2003, 369 lung transplantations (including 7 retransplantations) were performed on 362 patients. This report describes our experience and the changes in the management of lung transplantation during this time.

Results

From January 23, 1992 to December 31, 2003, 362 lung transplantations (retransplantations not included) were performed at this center: 228 SLT, 112 DLT (68 bloc-DLT and 44 sequential-DLT), 21 HLT, and 1 lobar lung transplant (Table 1 and Figure 1). All donors were cadaveric donors with the exception of the lobar transplantation, in which the donor was the patient’s living relative (mother). Two of the bloc-DLT recipients received additional organs from their respective donors (1 renal and 1

Discussion

The introduction of lung transplantation in Denmark occurred in 1992 after a long period of detailed planning. The Copenhagen University Hospital, Rigshospitalet, has since been the only lung transplantation center in Denmark and has been responsible for 369 lung transplantations over a 13-year period. The accumulated results from this series demonstrate substantially better actuarial survival rates than the most recent survival statistics from the international registry, which published 1-,

Conclusion

The results from the Danish National Lung Transplantation Centre show a lower peri-operative mortality rate and higher survival rates in all aspects of lung transplantation compared with international multicenter series. This retrospective survival study from a large single center demonstrates significant survival differences between the different disease groups and identifies donor age, recipient age, and recipient pre-operative BMI as independent predictors of poor survival. SLT is a

References (25)

S. Charman et al.
Assessment of survival benefit after lung transplantation by patient diagnosis
J Heart Lung Transplant
(2002)
J. Hosenpud et al.
The Registry of the International Society for Heart and Lung Transplantationsixteenth official report—1999
J Heart Lung Transplant
(1999)
M.A. Nørgaard et al.
Medium-term patency and anatomical changes after direct bronchial artery revascularisation in lung and heart-lung transplantation with the internal thoracic artery as conduit
J Thorac Cardiovasc Surg
(1997)
E. Trulock et al.
The Registry of the International Society for Heart and Lung Transplantationtwentieth official adult lung and heart-lung rransplant report—2003
J Heart Lung
(2003)
M. de Perrot et al.
Twenty-year experience of lung transplantation at a single centreinfluence of recipient diagnosis on long-term survival
J Thorac Cardiovasc Surg
(2004)
J. Christie et al.
Primary graft failure following lung transplantation
Chest
(1998)
S. Cassivi et al.
Thirteen-year experience in lung transplantation for emphysema
Ann Thorac Surg
(2002)
D.M. Meyer et al.
Single versus bilateral sequential lung transplantationinfluence of recipient age on survival and secondary end-points
J Heart Lung Transplant
(2001)
J. Hosenpud et al.
The Registry of the International Society for Heart and Lung Transplantationeighteenth official report—2001
J Heart Lung
(2001)
A. Haverich
Experience with lung transplantation
Ann Thorac Surg
(1999)

J.D. Hosenpud et al.

Effect of diagnostic group on survival benefit of lung transplantation for end-stage lung disease

Lancet

(1998)

G. Thabut et al.

Primary graft failure following lung transplantationpredictive factors of mortality

Chest

(2002)

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Clinical lung and heart/lung transplantationThe Copenhagen National Lung Transplant Group: Survival after Single Lung, Double Lung, and Heart-Lung Transplantation

Objective

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Conclusion

J Heart Lung Transplant

J Heart Lung Transplant

J Thorac Cardiovasc Surg

J Heart Lung

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

J Heart Lung Transplant

J Heart Lung

Ann Thorac Surg

Lancet

Chest

Clinical lung and heart/lung transplantation
The Copenhagen National Lung Transplant Group: Survival after Single Lung, Double Lung, and Heart-Lung Transplantation