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HEART LUNG TRANSPLANTATION RISKS RESULTS
Category: Cardiovascular Surgery
Abstract : General anesthesia and cardiopulmonary bypass carry certain risks
unassociated with the heart-lung transplant procedure. Graft rejection and
technical failure are a result of lung injury sustained during the stoppage and
restarting of the organ. Infection by cytomegalovirus (CMV) occurs in the first
year, but is usually treatable. Immunosuppressive drugs to prevent rejection
have side ef
General anesthesia and cardiopulmonary bypass carry certain risks
unassociated with the heart-lung transplant procedure. Graft rejection and
technical failure are a result of lung injury sustained during the stoppage and
restarting of the organ. Infection by cytomegalovirus (CMV) occurs in the first
year, but is usually treatable.
Immunosuppressive drugs to prevent rejection
have side effects associated with malignancies; lymphomas or tumors of the skin
and lips being most common. Osteoporosis and nephrotoxicity are also associated
with the immunosuppressive therapies.
Normal results
Lung and cardiac function are drastically improved after
transplantation. Strenuous exercise may still be limited, but quality of life is
greatly improved. Of all heartlung transplant recipients, 90% are satisfied with
their de- cisions to undergo the transplantation procedure. The patient will
continue with medical visits frequently throughout the first year, including
required tissue biopsies and cardiac catheterizations. The frequency of medical
visits will decrease after the first year, but invasive medical procedures will
still be necessary. Medications to suppress rejection of the organs and prevent
infection are continued.
Morbidity and mortality rates
Systemic hypertension is common in almost
half the patients at one year after surgery and can be relieved with medical
treatment. Chronic bronchiolitis is expected in one-third of patients at five
years. Hyperlipidemia (high lipid concentration in blood), diabetes mellitus,
and kidney dysfunction are also seen in some patients within the first year of
transplantation and continue to affect an increasing number of patients each
year. Malignancies that include lymphoma and lip and skin tumors are seen at a
higher rate than in general populations. Death within the first 30 days is
usually associated with technical and graft failure of the transplanted organ.
Rejection of the cardiac organ includes chronic coronary artery disease
affecting a small percentage of patients, while bronchiolitis (inflammation
caused by rejection of the lung) is responsible for the death of 60% of patients
between the first and fifth years. Untreatable infections are a persistent
complication in the initial 30 days and continue to affect patients into the
fifth year, and result in death. Acute rejection is uncommon, but it is a
complication that can also lead to death. Five-year mortality is higher for
patients with ventilator dependence, retransplantation, congenital disease, and
in recipients over 60 years of age.
Alternatives
Heart-lung transplants are becoming less common. Since 1990,
only 40 to 60 of these procedures are performed every year in the United States.
The outcomes of single- and double-lung transplantation have provided good
success for pathologies where the cardiac function is not jeopardized.
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