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Lung Transplants Warranted In Cystic Fibrosis
A DGReview of :"Long term results of lung transplantation for cystic fibrosis."
European Journal of Cardio-Thoracic Surgery
10/07/2002
By David Loshak
Bilateral sequential lung transplants result in acceptable long-term survival in cystic fibrosis adults and children with end stage disease.
Even though patients colonised with Burkholderia cepacia have a worse outcome, transplantation is still warranted, say specialists in the Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, North Carolina, United States.
To pinpoint the factors which influenced long-term survival, the specialists reviewed their experience with 131 lung transplants for cystic fibrosis in 123 patients over a 10-year period.
Of these, 114 had bilateral sequential lung transplants and nine had bilateral lower lobe transplants from living donors. Three patients had retransplants for acute graft failure and five patients had late retransplant for bronchiolitis obliterans syndrome.
The actuarial survival for the entire group of bilateral sequential lung transplants cystic fibrosis patients was 81 percent at one year, 59 percent at five years and 38 percent at 10 years. Lobar transplant was associated with poorer survival (37.5 percent at one and five years).
Of the 114 bilateral sequential lung transplants patients, 22 had colonisation with Burkholderia cepacia. This was associated with poorer outcomes than in non-cepacia patients - 60 percent versus 86 percent at one year and 36 percent versus 64 percent at five years.
Survival duration was similar in the 22 bilateral sequential lung transplants patients who were younger than 20 years and the 90 who were older. Being on a ventilator at the time of transplant (n=8) was not associated with poorer survival.
Noting that bronchiolitis obliterans syndrome affects more survivors with time, the specialists reported that five cystic fibrosis patients were retransplanted because of it. There was one operative death and one-year survival was 60 percent.
European Journal of Cardio-Thoracic Surgery 2002; 22(4):602.
"Long term results of lung transplantation for cystic fibrosis."
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