Thirteen-year experience in lung transplantation for emphysema

Stephen D. Cassivi, Bryan F. Meyers, Richard J Battafarano, Tracey J. Guthrie, Elbert P. Trulock, John P. Lynch, Joel D. Cooper, G. Alexander Patterson

Research output: Contribution to journalArticle

Abstract

Background. Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups. Methods. A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years. Results. The mean age of AAD recipients (49 ± 6 years) was less than those with COPD (55 ± 6 years; p <0.001). Hospital mortality was 6.2%, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p = 0.044). Five-year survival was 58.6% ± 3.5%, with no difference between COPD (56.8% ± 4.4%) and AAD (60.5% ± 5.8%). Five-year survival was better with bilateral-lung transplants (66.7% ± 4.0%) than with singlelung transplants (44.9% ± 6.0%, p <0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p <0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038). Conclusions. AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.

Original languageEnglish (US)
Pages (from-to)1663-1670
Number of pages8
JournalAnnals of Thoracic Surgery
Volume74
Issue number5
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

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alpha 1-Antitrypsin Deficiency
Lung Transplantation
Emphysema
Chronic Obstructive Pulmonary Disease
Transplants
Lung
Hospital Mortality
Survival
Perioperative Care
Mortality
Cardiopulmonary Bypass
Autosomal Recessive alpha-1-Antitrypsin Deficiency
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cassivi, S. D., Meyers, B. F., Battafarano, R. J., Guthrie, T. J., Trulock, E. P., Lynch, J. P., ... Patterson, G. A. (2002). Thirteen-year experience in lung transplantation for emphysema. Annals of Thoracic Surgery, 74(5), 1663-1670. https://doi.org/10.1016/S0003-4975(02)04064-X

Thirteen-year experience in lung transplantation for emphysema. / Cassivi, Stephen D.; Meyers, Bryan F.; Battafarano, Richard J; Guthrie, Tracey J.; Trulock, Elbert P.; Lynch, John P.; Cooper, Joel D.; Patterson, G. Alexander.

In: Annals of Thoracic Surgery, Vol. 74, No. 5, 01.11.2002, p. 1663-1670.

Research output: Contribution to journalArticle

Cassivi, SD, Meyers, BF, Battafarano, RJ, Guthrie, TJ, Trulock, EP, Lynch, JP, Cooper, JD & Patterson, GA 2002, 'Thirteen-year experience in lung transplantation for emphysema', Annals of Thoracic Surgery, vol. 74, no. 5, pp. 1663-1670. https://doi.org/10.1016/S0003-4975(02)04064-X
Cassivi, Stephen D. ; Meyers, Bryan F. ; Battafarano, Richard J ; Guthrie, Tracey J. ; Trulock, Elbert P. ; Lynch, John P. ; Cooper, Joel D. ; Patterson, G. Alexander. / Thirteen-year experience in lung transplantation for emphysema. In: Annals of Thoracic Surgery. 2002 ; Vol. 74, No. 5. pp. 1663-1670.
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abstract = "Background. Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups. Methods. A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years. Results. The mean age of AAD recipients (49 ± 6 years) was less than those with COPD (55 ± 6 years; p <0.001). Hospital mortality was 6.2{\%}, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9{\%} vs 9.5{\%}, p = 0.044). Five-year survival was 58.6{\%} ± 3.5{\%}, with no difference between COPD (56.8{\%} ± 4.4{\%}) and AAD (60.5{\%} ± 5.8{\%}). Five-year survival was better with bilateral-lung transplants (66.7{\%} ± 4.0{\%}) than with singlelung transplants (44.9{\%} ± 6.0{\%}, p <0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p <0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038). Conclusions. AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.",
author = "Cassivi, {Stephen D.} and Meyers, {Bryan F.} and Battafarano, {Richard J} and Guthrie, {Tracey J.} and Trulock, {Elbert P.} and Lynch, {John P.} and Cooper, {Joel D.} and Patterson, {G. Alexander}",
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T1 - Thirteen-year experience in lung transplantation for emphysema

AU - Cassivi, Stephen D.

AU - Meyers, Bryan F.

AU - Battafarano, Richard J

AU - Guthrie, Tracey J.

AU - Trulock, Elbert P.

AU - Lynch, John P.

AU - Cooper, Joel D.

AU - Patterson, G. Alexander

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Y1 - 2002/11/1

N2 - Background. Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups. Methods. A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years. Results. The mean age of AAD recipients (49 ± 6 years) was less than those with COPD (55 ± 6 years; p <0.001). Hospital mortality was 6.2%, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p = 0.044). Five-year survival was 58.6% ± 3.5%, with no difference between COPD (56.8% ± 4.4%) and AAD (60.5% ± 5.8%). Five-year survival was better with bilateral-lung transplants (66.7% ± 4.0%) than with singlelung transplants (44.9% ± 6.0%, p <0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p <0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038). Conclusions. AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.

AB - Background. Emphysema is the most common indication for lung transplantation. Recipients include younger patients with genetically determined alpha-1 antitrypsin deficiency (AAD) and, more commonly, patients with chronic obstructive pulmonary disease (COPD). We analyzed the results of our single-institution series of lung transplants for emphysema to identify outcome differences and factors predicting mortality and morbidity in these two groups. Methods. A retrospective analysis was undertaken of the 306 consecutive lung transplants for emphysema performed at our institution between 1988 and 2000 (220 COPD, 86 AAD). Follow-up was complete and averaged 3.7 years. Results. The mean age of AAD recipients (49 ± 6 years) was less than those with COPD (55 ± 6 years; p <0.001). Hospital mortality was 6.2%, with no difference between COPD and AAD, or between single-lung transplants and bilateral-lung transplants. Hospital mortality during the most recent 6 years was significantly lower (3.9% vs 9.5%, p = 0.044). Five-year survival was 58.6% ± 3.5%, with no difference between COPD (56.8% ± 4.4%) and AAD (60.5% ± 5.8%). Five-year survival was better with bilateral-lung transplants (66.7% ± 4.0%) than with singlelung transplants (44.9% ± 6.0%, p <0.005). Independent predictors of mortality by Cox analysis were single lung transplantation (relative hazard = 1.98, p <0.001), and need for cardiopulmonary bypass during the transplant (relative hazard = 1.84, p = 0.038). Conclusions. AAD recipients, despite a younger age, do not achieve significantly superior survival results than those with COPD. Bilateral lung transplantation for emphysema results in better long-term survival. Accumulated experience and modifications in perioperative care over our 13-year series may explain recently improved early and long-term survival.

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