25-year follow-up after lung transplantation at Lund University Hospital in Sweden: superior results obtained for patients with cystic fibrosis

Abstract

Objectives: In Sweden, two centres perform lung transplantation for a population of about 9 million and the entire population is covered for lung transplantation by government health insurance. Lund University Hospital is one of these centres. This retrospective report reviews the 25-year experience of the Skåne University Hospital Lung Transplant Program with particular emphasis on short-term outcome and long-term survival but also between different subgroups of patients and types of transplant [single-lung transplantation (SLTx) versus double-lung transplantation (DLTx)] procedure performed.

Methods: Between January 1990 and June 2014, 278 patients underwent lung transplantation at the Skåne University Hospital Sweden. DLTx was performed in 172 patients, SLTx was performed in 97 patients and heart-lung transplantation was performed in 9 patients. In addition, 15 patients required retransplantation (7 DLTx and 8 SLTx).

Results: Overall 1-, 5-, 10-, 15- and 20-year survival rates were 88, 65, 49, 37 and 19% for the whole cohort. DLTx recipients showed 1-, 5-, 10- and 20-year survival rates of 90, 71, 60 and 30%, compared with SLTx recipients with 1-, 5-, 10- and 20-year survival rates of 83, 57, 34 and 6% (P < 0.05), respectively. Comparing the use of intraoperative extracorporeal membrane oxygenation, extracorporeal circulation (ECC) and no circulatory support in the aspect of survival, a significant difference in favour of intraoperative ECC was seen.

Conclusions: Superior long-term survival rates were seen in recipients diagnosed with cystic fibrosis, α1-antitrypsin deficiency and pulmonary hypertension. DLTx showed better results compared with SLTx especially at 10 years post-transplant. In the present study, we present cumulative incidence rates of bronchiolitis obliterans syndrome of 15% at 5 years, 26% at 10 years and 32% at 20 years post-transplant; these figures are in line with the lowest rates presented internationally.

Keywords: Cystic fibrosis; Long-term follow-up; Lung; Survival; Transplantation.

© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Figures

Figure 1:

Number and type of transplant performed by year at Skåne University Hospital. HLTx: heart–lung transplant; DLTx: double-lung transplant; SLTx: single-lung transplant; ReTx: re-transplant.

Figure 2:

Overall survival after lung transplantation at Skåne University Hospital from January 1990 to June 2014, with a total of 278 patients (top left). Survival for recipients with COPD and AAT1 (P > 0.05) (top right). Survival for recipients with CF and PF (P > 0.05) (bottom, left). Survival for recipients with PH (bottom right). COPD: chronic obstructive pulmonary disease; AAT1: α1-antitrypsine deficiency; CF: cystic fibrosis; PH: pulmonary hypertension; PF: pulmonary fibrosis.

Figure 3:

Survival by type of transplant after lung transplantation at Skåne University Hospital from January 1990 to June 2014. HLTx (n = 9), DLTx (n = 172) and SLTx (n = 97) (P < 0.05) (top left). Survival in COPD patients by type of transplants, SLTx versus DLTx (P > 0.05) (top right). Survival in AAT1 patients by type of transplant, SLTx versus DLTx (P < 0.05) (bottom left). COPD: chronic obstructive pulmonary disease; HLTx: heart–lung transplantation; DLTx: double-lung transplantation; SLTx: single-lung transplantation.

Figure 4:

Cumulative incidence of BOS and death, after lung transplantation at Skåne University Hospital from January 1990 to June 2014, for all recipients. BOS: bronchiolitis obliterans syndrome; SLTx: single-lung transplantation; HLTx: heart–lung transplantation; DLTx: double-lung transplantation.