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The Annals of Thoracic Surgery, Vol 55, 1087-1091, Copyright © 1993 by The Society of Thoracic Surgeons
G Massard, H Shennib, D Metras, J Camboulives, L Viard, DS Mulder, CI Tchervenkov, JF Morin, R Giudicelli and M Noirclerc
Many lung transplant programs consider ventilator dependence as a
contraindication for transplantation. Among 54 patients in whom bilateral
lung transplantations for cystic fibrosis were performed by the Joint
Marseille-Montreal Lung Transplant Program, 10 were ventilator dependent.
Three of them died in the early postoperative period (30%): 2 as a result
of cerebral anoxia and sepsis, 1 of Pseudomonas cepacia pneumonia. Two
patients died at 15 and 19 months after transplantation of obliterative
bronchiolitis and secondary bacterial pneumonitis. Another 2 patients in
whom obliterative bronchiolitis developed underwent retransplantation with
a heart-lung block; 1 of those was operated on at 12 months and is well at
29 months after his initial transplantation; the second was operated on at
34 months and died of primary graft failure. Three other patients are alive
and well at 3, 11, and 14 months after transplantation. Actuarial survival
at 1 year was 70%. The postoperative course and the infectious and
rejection complications were no different from those in patients who
underwent transplantation while spontaneously breathing. Obliterative
bronchiolitis developed in 66% of patients at risk (2 of 6 patients
surviving more than 6 months). We conclude that transplantation in
mechanically ventilated patients with cystic fibrosis is not associated
with an increase in morbidity or mortality after bilateral lung
transplantation. Long-term survival, as in patients who undergo
transplantation while spontaneously breathing, is limited by the
development of obliterative bronchiolitis.
ARTICLES
Double-lung transplantation in mechanically ventilated patients with cystic fibrosis
Joint Marseille-Montreal Lung Transplant Program, Marseille, France.
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