The Annals of Thoracic Surgery, Vol 38, 554-562, Copyright © 1984 by The Society of Thoracic Surgeons
Heart-lung transplantation for irreversible pulmonary hypertension
SW Jamieson, EB Stinson, PE Oyer, BA Reitz, J Baldwin, D Modry, K Dawkins, J Theodore, S Hunt and NE Shumway
Combined heart and lung transplantation was carried out in 17 patients at
Stanford University between March, 1981, and December, 1983. The recipients
were between 22 and 45 years old. All patients had end-stage pulmonary
hypertension; 10 had Eisenmenger's syndrome and the remaining 7, primary
pulmonary hypertension. Five patients died within the first few
postoperative weeks. The remainder are well between four weeks and 33
months from operation. The immunosuppressive protocol has consisted of
cyclosporine with an initial course of rabbit antithymocyte globulin.
Azathioprine also was given for the first two weeks and then was replaced
with prednisone. Rejection, as diagnosed by cardiac biopsy, was treated
with high doses of methylprednisolone. Modifications of technique that have
developed include the removal of the recipient heart and lungs separately,
and preservation of the lungs with a modified Collins' solution instead of
a cardioplegic solution. Rejection occurred in 6 of the 12 survivors.
Infections developed in 9 patients, but only one resulted in a fatal
outcome (Legionella). Thus, the results of clinical heart-lung
transplantation have been considerably superior to clinical efforts in lung
transplantation. It is suggested that the combined operation is preferable
for the following reasons: (1) all diseased tissue is removed, thus
eliminating recurrent infection and ventilation/perfusion disparity; (2)
transplantation of the entire heart-lung block preserves coronary-
bronchial vascular anastomoses and makes airway dehiscence less likely; and
(3) to date, diagnosis of rejection by cardiac biopsy has appeared to be a
satisfactory method of diagnosing and treating pulmonary
rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
