Elsevier

Transplantation Proceedings

Volume 41, Issue 7, September 2009, Pages 2887-2889
Transplantation Proceedings

Thoracic transplantation
Eight Years of Lung Transplantation: Experience of the National Research Institute of Tuberculosis and Lung Diseases

https://doi.org/10.1016/j.transproceed.2009.07.016Get rights and content

Abstract

Background

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006.

Objective

To describe our 8-year experience in lung transplantation.

Patients and Methods

During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation.

Results

The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection.

Conclusion

Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.

Section snippets

Patients and Methods

The study included data for all patients who underwent lung transplantation, as well as those on the waiting list, collected from 2000 to 2008. Data included patient age and sex, underlying disease, date of transplantation procedure, type of transplant (single or bilateral), ABO blood group, cytomegalovirus seropositivity of donor and recipient, and results of transplantation. At our center, indications and contraindications for lung transplantation are consistent with widely accepted criteria.2

Results

Approximately 170 patients were listed for lung transplantation during the 8-year study. The cause of end-stage pulmonary disease was bronchiectasis in 37.0%, chronic obstructive pulmonary disease in 24.7%, pulmonary fibrosis in 22.1%, and primary pulmonary hypertension in 16.2%. Mean time on the waiting list is about 2 years; 25% of patients in the list die each year, and only 2% to 4% undergo lung transplantation.

Of our 24 patients, the underlying lung diseases were pulmonary fibrosis

Discussion

Lung transplantation is one of the most difficult medical practices because of patient preparation, the surgical procedure, and postoperative care. As a result, there are fewer lung transplantation centers compared with other organ transplantation centers.

Approximately 17 to 30 patients come to the hospital transplant clinic weekly. Because of the shortage of donors, both the number of candidates awaiting transplantation and the number of patients who die while on waiting list are increasing.

In

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