1 / 22

Survival after single versus bilateral lung transplantation for COPD and pulmonary fibrosis

Survival after single versus bilateral lung transplantation for COPD and pulmonary fibrosis. A. Demir, D. Van Raemdonck, G. Verleden, L. Dupont, W. Coosemans, H. Decaluwé, P. De Leyn, P. Nafteux, T. Lerut. University Hospital Gasthuisberg Leuven Belgium.

kass
Download Presentation

Survival after single versus bilateral lung transplantation for COPD and pulmonary fibrosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Survival after single versus bilateral lung transplantation for COPD and pulmonary fibrosis A. Demir, D. Van Raemdonck, G. Verleden, L. Dupont, W. Coosemans, H. Decaluwé, P. De Leyn, P. Nafteux, T. Lerut University HospitalGasthuisberg Leuven Belgium

  2. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. ISHLT 2009

  3. ADULT LUNG TRANSPLANTATION: Indications(1/1995-6/2008) ISHLT 2009

  4. ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications(1992-2007) ISHLT 2009

  5. ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year ISHLT 2009

  6. ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2008) *Other includes: Sarcoidosis: 2.1% Bronchiectasis: 0.4% Congenital Heart Disease: 0.2% LAM: 0.8% OB (non-ReTx): 0.5% Miscellaneous: 6.3% ISHLT 2009

  7. ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2008) *Other includes: Sarcoidosis: 2.9% Bronchiectasis: 4.5% Congenital Heart Disease: 1.1% LAM: 1.2% OB (non-ReTx): 1.1% Miscellaneous: 7.7% ISHLT 2009

  8. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2007) ISHLT 2009

  9. Aim • Whether single lung transplantation (SLTx) or bilateral lung transplantation (BLTx) should be preferred for patients with end-stage pulmonary fibrosis and COPD remains unknown. • The objective of this retrospective study was to analyze factors recorded in a prospective database that are predictive for long-term survival in our lung transplant cohort

  10. Patients and Methods • Between July 1991 and December 2009 • 329 LTx with COPD and Fibrotic patients, • 193 M and 136 F, Mean age:54.5 years [23-69] • COPD patients (n=226) • BLTx (65%) • SLTx (35%) • Fibrotic patients (n=103) • SLTx (56%) • BLTx (44%)

  11. The overall 5 and 10-year survival rate was 65% and 51% for recipients with COPD and 57% and 41% recipients with pulmonary fibrosis (p=0.09).

  12. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis(Transplants: January 1990 – June 2007) Survival comparisons Alpha-1 vs. CF: p < 0.0001Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs.Sarcoidosis: p = 0.0380 CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001 CF vs. IPAH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001 IPAH vs. IPF: p = 0.0046 COPD vs. IPF: p < 0.0001 Note: Other comparisons are not statistically different. ISHLT 2009

  13. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis(Transplants: January 1990 – June 2007) Survival comparisons Alpha-1 vs. CF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs.Sarcoidosis: p = 0.0380 CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 CF vs. IPAH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001 IPAH vs. IPF: p = 0.0046 COPD vs. IPF: p < 0.0001 ISHLT 2009

  14. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD ISHLT 2009

  15. Overall 5-year survival rate was higher after BLTX compared to SLTx in recipients with COPD (77% vs. 49%; p < 0.001)

  16. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type(Transplants: January 1990 – June 2007)Diagnosis: Idiopathic Pulmonary Fibrosis ISHLT 2009

  17. Overall 5-year survival rate wasn’t after BLTX compared to SLTxin recipients with fibrosis (55% versus 56%; p=0.35)

  18. Bilateral versus single lung transplantation was not a predictor of early (30 day) and late (60 day) mortality after LTx in recipients with COPD and pulmonary fibrosis (p>0.05). • The length of the ICU stay in the bilateral group was significantly longer after LTx in recipients with COPD (p=0.03).

  19. Conclusion • Mortality, morbidity and long-term survival did not differ between BLTx vs SLTx in patients with pulmonary fibrosis.. However, BLTx leads to better long-term survival in recipients with COPD. SLTx may result in fatal complications in the remaining native emphysematous lung.

  20. Potential advantages for SSLTx • No more native lung present • Specific native lung problems may be avoided • Acute hyperinflation • Chronic hyperinflation • Infectıon • Effect of aspergillus pneumonia native lung • Tumour of the natıve lung • Survival benefit (?) • Early postoperative • Late: BOS development • Better QOL and performance?

  21. Potential disadvantages • Increasing waiting lists • Why using two lungs if one may be sufficient? • Increasing waiting list mortality

More Related