LUNG TRANSPLANTATION

2. CURRENT STATUS
Lung transplantation are currently indicated for patients with advanced forms of
lung disease, in whom no realistic hope for extension of life or palliation exists
with ordinary forms of medical or surgical intervention. Since, the introduction of
Cyclosporine in December, 1980, and further refinements in management
strategies have moved biologic lung transplantation from an experimental study to
a truly therapeutic procedure with a one year survival rate of 75% to 80% and an
expected five year survival rate of 45% to 55% in the best centres. As of 2003, the
most recent data from the International Heart Transplant Registry indicates that
more than 15000 lung transplants, were performed worldwide.
2.1 Indications
a. Single Lung Transplantation - emphysema (44%), idiopathic pulmonary
fibrosis (17.9%), alpha 1 anti-trypsin deficiency (12.8%), primary
pulmonary hypertension (7.5%), re-transplant (3.3%), cystic fibrosis
(1.6%), miscellaneous (12.9%).
b. Bilateral/Double Lung Transplantation - cystic fibrosis (37.5%),
emphysema (15.6%), alpha 1 anti-trypsin deficiency (10.2%), primary
pulmonary hypertension (11%), idiopathic pulmonary fibrosis (5.8%), retransplant
(3.6%), miscellaneous (16.3%).
2.2 Outcomes
Lung actuarial survival for single lung at 1year is approximately 75%, 5 years
is approximately 45-55%. Bilateral or double lung transplantation survival is
similar.
Better results may be achieved with emphysema and alpha I anti-trypsin
deficiency with 1year and 2 year survival rates in the order of 77% and 70%
respectively compared to idiopathic pulmonary fibrosis and primary
pulmonary hypertension with 1 and 2 year survival rates of 65% and 57%
respectively.
Comparable results have been achieved with double lung transplantation in
this same era. Of interest, single lung transplantation and has a one year
survival rate for patients with emphysema of 80% at 1year as opposed to
bilateral or double lung transplantation for which the 1 year survival rate
has been 60%. For primary pulmonary hypertension, the 18-month survival
rate for single lung and bilateral double lung transplantation is
approximately 64% and for heart/lung transplantation approximately 55%.
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