Heart-lung transplantation at stanford university since 1981

Purpose: Long-term survival after heart-lung transplantation (HLTx) was first achieved in 1981 at Stanford. This is the longest retrospective single-center study summarizing our 27-year experience. Methods and Materials: Medical records of all HLTx performed at Stanford between 3/1981 and 6/2008 were reviewed. Results: A total of 217 HLTx were performed in 212 patients with a mean age of 31.2±12.1 years, ranging between 49 days and 58 years. Overall 1- and 10-year survival started at 62.1% and 17.2% in 1981-1985, and improved to 100% and 41.2%, respectively, in recent years. Median survival was similar for the three most common diagnoses congenital disease (6.5 years), primary pulmonary hypertension (4.3 years), and cystic fibrosis (5.9 years), p=0.464. Only 23.7%, 29.0%, and 31.6% of all patients did not experience cellular rejection in the 1980s, 1990s, and 2000s, respectively. Freedom from infection was only 8.2% after 1 year and 0% by 5 years. Freedom from bronchiolitis obliterans syndrome (BOS) was 96.4%, 66.7%, and 50.2%, and freedom from graft vasculopathy was 99.3%, 94.1%, and 65.8% after 1, 5, and 10 years, respectively. Less than 20% of the patients developed posttransplant malignancy within the first 10 years, but the rate doubled to 40% after 15 years. Infection (48.1%) and obliterative bronchiolitis (38.2%) were the main cause of death within 1 year and between 5 and 10 years, respectively. Of 153 patients transplanted between 3/1981 and 6/1998, 46 (30.1%) survived >10 years and 78 (51.0%) survived <5 years. Comparing these groups, 10-year survivors had significantly fewer CMV D+/R- combinations (20.0% vs. 33.3%) and experienced significantly fewer rejection episodes within the first year (0.9±1.0 vs. 1.5±1.0, p=0.005). Eight patients lived longer than 20 years.None of these patients had prior chest surgery. Only 0.5±0.6 rejection episodes were reported in this patient population. Conclusions: Huge improvements have been achieved over the last 27 years. However, strategies to control BOS will be needed in order to achieve routine longterm survival.