The Annals of Thoracic Surgery, Vol 49, 840-844, Copyright © 1990 by The Society of Thoracic Surgeons
Lung and heart-lung transplantation
YM LeGal
Department of Surgery, Memorial University of Newfoundland, Canada.
Unilateral lung transplantation has become a successful method for the
treatment of end-stage pulmonary disease, whereas double-lung
transplantation has provided benefit to patients with nonfibrotic lung
disease such as emphysema and cystic fibrosis. In the past 5 years, 16
single-lung and 13 double-lung transplantations have been performed by the
Toronto Lung Transplant Group in patients with end-stage lung disease.
Seven perioperative and two late deaths have been recorded so far. Since
the introduction of heart-lung transplantation at Stanford in 1981 and at
Pittsburgh in 1982 for the treatment of Eisenmenger's syndrome and terminal
pulmonary vascular disease, more than 350 combined heart-lung
transplantations have been carried out throughout the world. Presently, the
2-year actuarial survival is about 62%. The long-term results have not yet
reached the same level of success as those of cardiac transplantation
alone. Although several factors have played a role in this difference, a
prominent cause has been the lack of a reliable and simple method for
pulmonary protection against prolonged ischemia. Most of the techniques
proposed against ischemia can be classified as normothermic or static
hypothermic cardiopulmonary preservation. The use of the normothermic
method has not always been successful. For this reason, interest has now
been directed toward the potential for hypothermic preservation of the
heart-lung bloc and the use of free-radical scavenger therapy in the
reduction of reperfusion injury.
