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Outcome of heart–lung and bilateral sequential lung transplantation for cystic fibrosis: a UK national study

UK Cardiothoracic Transplant Audit, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK

CORRESPONDENCE: N. R. Banner, Cardiothoracic Transplant Unit, Royal Brompton & Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK. Fax: 44 1895828556. E-mail: n.banner@rbh.nthames.nhs.uk

Keywords: Adults, cystic fibrosis, lung transplantation, outcomes, survival

Received: June 17, 2004
Accepted February 24, 2005

Cystic fibrosis (CF) patients requiring transplantation for respiratory failure may undergo either heart–lung (HLT) or bilateral sequential lung (BSLT) transplantation. The choice of operation varies between surgeons, centres and countries.

The current authors investigated whether operation type influenced outcome in adult CF patients transplanted in the UK between July 1995 and June 2002. Propensity scores for receipt of BSLT versus HLT were derived using logistic regression. Cox regression was used to compare survival.

In total, 88 BSLTs and 93 HLTs were identified. Patient characteristics were similar overall, but HLT recipients were more likely to be on long-term oxygen therapy and to have had prior resuscitation. There were 72 deaths (29 BSLT and 43 HLT) within 4 yrs. There was a trend towards higher unadjusted survival following BSLT, but, after adjustment, no difference was found (hazard ratio = 0.77; 95% confidence interval 0.29–2.06). Time to the first rejection episode and infection rates were also similar. A total of 82% of hearts from HLT recipients were used as domino heart transplants.

In conclusion, after adjusting for comorbidity, donor factors and ischaemia time, it was found that heart–lung and bilateral sequential lung transplantation achieved a similar outcome. The use of domino heart transplantation ameliorated the impact of heart–lung transplantation on total organ availability.

This article has been cited by other articles:

				G Meachery, A De Soyza, A Nicholson, G Parry, A Hasan, K Tocewicz, T Pillay, S Clark, J L Lordan, S Schueler, et al. Outcomes of lung transplantation for cystic fibrosis in a large UK cohort Thorax, August 1, 2008; 63(8): 725 - 731. [Abstract] [Full Text] [PDF]

				J. S. Ganesh, C. A. Rogers, N. R. Banner, R. S. Bonser, and Steering Group of the UK Cardiothoracic Transplant Does the method of lung preservation influence outcome after transplantation? An analysis of 681 consecutive procedures. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1313 - 1321. [Abstract] [Full Text] [PDF]

				P. Thomas Lung versus heart-lung transplantation for cystic fibrosis: is the debate still open? Eur. Respir. J., June 1, 2005; 25(6): 947 - 948. [Full Text] [PDF]