Lung and heart-lung transplantation by asafwewe

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									2002/N   20/12/02    9:57 am        Page 1



                                                                                                                                                                                    Factsheet 2002/2

                                                                                                  Lung and heart-lung
                                                                                                    transplantation
              Public Health Sciences Dept., St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE               laia@sghms.ac.uk                     http://www.sghms.ac.uk/depts/laia/laia.htm



           Lung and heart-lung transplants were first successfully                                    Figure 1: Numbers of heart-lung and lung
           completed two decades ago. Since then they have been                                       transplants in UK and Ireland, 1991- 2001
           increasingly considered for patients with certain lung
           diseases where no other treatment is available, in order to
           improve very limited life expectancy or very poor quality of                                   180
                                                                                                                                                               Lung            Heart-lung

           life.                                                                                          160

                                                                                                                                                          52          57       53
           This factsheet presents data from the National Transplant                                      140

                                                                                                                                                                                          44
                                                                                                                                                                                                             50

                                                                                                          120
           Database on heart-lung and lung transplants in the UK and                                                    78
                                                                                                                                     52
                                                                                                                                               35                                                   52                     33
                                                                                                                                                                                                                                     32
                                                                                                          100
           the Republic of Ireland since 1991, published by UK
                                                                                                           80
           Transplant (see footnote).                                                                                                                                         116
                                                                                                           60                                            115         112
                                                                                                                                               95                                         103               110            98
                                                                                                                                     91
           Trends                                                                                          40           73
                                                                                                                                                                                                    88                               93


                                                                                                           20

           Heart-lung transplants were the first to be implemented,                                           0
                                                                                                                        1991        1992      1993       1994        1995    1996         1997     1998    1999           2000      2001
           initially in cases where there was pulmonary vascular                                                                                                             Year
           disease and later for those with certain other lung diseases
           and complex heart defects. In the UK they are often used
           for patients with cystic fibrosis. Over time there have been
           more lung only transplants, both single and double. Very
           occasionally lobes from lung donors have been                                             Figure 2: Trend in cause of death in lung donors in
           transplanted.                                                                             UK and Ireland, 1989-2001

           There were 1632 heart-lung and lung transplants from 1991
           to 2001, of which two-thirds were lung transplants (figure                                                    1000
                                                                                                                                                         N = 944
                                                                                                                                                         (100%)
                                                                                                                                                                                               N = 868
           1). There has been no clear trend over the period with                                                         900
                                                                                                                                                               20%
                                                                                                                                                                                               (100%)
                                                                                                                                                                                                                  Other
           between 125 and 169 transplants being carried out each                                                         800                                                                    23%              Road Traffic Accidents
                                                                                                                                                                                                                  Intracranial causes
           year.                                                                                                          700

                                                                                                                          600                               33%                                  21%
           The highest number of heart-lung transplants during this                                                       500

           period was 78 in 1991. Over recent years the number has                                                        400

           been about 50 per year.                                                                                        300
                                                                                                                                                            46%                                  56%
                                                                                                                          200
           In contrast, the number of lung transplants increased from
                                                                                                                          100
           73 in 1991 to a peak of 116 in 1996. Since then numbers                                                             0
                                                                                                                                                                                            1996-2001
           have been stable at around 100 per year.                                                                                                     1989-1995
                                                                                                                                                                            Period


           Cause of death of donor
           Eighteen percent of all donors' lungs were utilised for lung
           transplantation in the period 1996-2001. The main cause of                                  Figure 3: Recipient and donor ages in heart-lung
           death of donors for whom lungs have been retrieved was                                      and lung transplants, 1997-2001 UK and Ireland
           intracranial causes (which includes intracranial bleeding)
           though patterns have changed over time. As Road Traffic
           Accidents (RTA) have fallen due to improvements in safety,                                    50

           so too have the number of lungs retrieved from RTAs. These                                    45                                                                 Heart-lung           Lung

           fell from 316 in the period 1989-95 (a third of lungs                                         40

                                                                                                         35
           retrieved) to 182 in 1996-2001 (a fifth). At the same time
                                                                                                         30
           lungs retrieved from deaths due to intracranial causes rose
                                                                                                         25
           moderately increasing the proportion of these deaths from                                     20
           46% to 56% while the number (and proportion) of deaths                                        15
           for other causes has remained stable.                                                         10


           Age                                                                                            5

                                                                                                          0
                                                                                                                  0-5    6-11      12-1718-3435-49      50-59 60-64 65+             0-5   6-11 12-1718-3435-4950-59         60-64    65+

           Heart-lung transplants were carried out in people aged up to                                                                    Recipients                                                     Donors

           55 years (figure 3). Fifteen percent of heart-lung transplants
           and four percent of lung transplants in recent years were in


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2002/N       20/12/02   9:58 am   Page 2




    the under 18s. Single / double lung transplants were carried
                                                                     Figure 4: Primary disease of heart / lung recipient
    out in an older range of patients from teenagers to the over     UK & Ireland, 1997-2001
    65s.                                                                           Congenital heart            Emphysema
                                                                                     disease 4%                   2%              Other heart disease
    Donors were younger than recipients with the under 18s                   Unknown/not
                                                                                                                                          1%

    providing 28% of heart-lung and 11% of lung transplant                   reported 4%

    donors. Twenty-three percent of heart-lung and fifteen           Fibrosing lung
                                                                      disease 5%                                                                 Cystic fibrosis
    percent of lung transplants were from donors from an older                                                                                       45%
    age band (not shown).                                                     Other
                                                                               8%
    Primary disease of recipient
    Between 1997 and 2001 heart-lung transplants were most
    often carried out in those with cystic fibrosis (45%) and             Eisenmengers
                                                                              10%
    primary pulmonary hypertension (21%) (figure 4). Ten
    percent of recipients suffered from Eisenmenger's
                                                                                      Primary pulmonary
    syndrome, a congenital heart problem that leads to                                   hypertension
    pulmonary hypertension. Recipients of lung transplants in                                21%

    the same period included those with emphysema (33%), a
    fibrosing lung disease (23%), cystic fibrosis (19%) or a
    congenital heart/lung disease (15%) (figure 5).
                                                                     Figure 5: Primary disease of lung only recipient
    Survival                                                         UK & Ireland 1997 - 2001
    From the time of the operation and for the rest of their lives                        Primary pulmonary
                                                                                                                       Other congenital heart/lung
                                                                                             hypertension
    patients must take immunosuppressive medications to try to                                   1%
                                                                                                                              disease 2%
    suppress rejection of the transplanted graft. Graft rejection       Cystic fibrosis                                                         Other
    is common within the first 3-6 months post transplantation.             19%                                                                 19%

    During this period immunosuppressive therapy is intense
    leading to increased risks of serious infections. After the                                                                                   Unknown/not
                                                                                                                                                  reported 2%
    first year the main causes of death are infection and
    bronchiolitis obliterans, an obstructive lung disease. Unlike
    other organ transplants, the lungs are constantly exposed to
    inhaled environmental pathogens. Lung and heart-lung
    transplants have lower survival rates than heart or liver           Fibrosing lung
                                                                         disease 23%                                                       Emphysema
    transplants. The 1, 3 and 5 year survival rate estimates for                                                                             34%
    heart-lung transplants were 69%, 59% and 47% respectively
    (figure 6). Survival estimates for lung transplantation were
    comparable at 76%, 57% and 42%.

    Summary
                                                                     Figure 6: Estimates of percentage surviving after 1,
                                                                     3 and 5 years for heart-lung and lung only
         •    During 1991-2001 there were 538 heart-lung and
                                                                     transplants, with 95% confidence intervals, UK &
              1094 lung transplants in the UK and the                Ireland 2000
              Republic of Ireland.
                                                                             100
         •    In 1989 to 1995, 33% of lung donors were from                   90
              Road Traffic Accidents compared to 21% in                       80

              1996 –2001.                                                     70

                                                                              60

         •    Heart-lung transplants were most commonly                       50

              carried out in those with cystic fibrosis and                   40

                                                                              30
              pulmonary hypertension.
                                                                              20

         •    The most common reasons for a lung only                         10

                                                                               0
              transplant were emphysema, fibrosing lung                               1 year     3 year       5 year          1 year   3 year    5 year

              disease and cystic fibrosis.                                                     Heart & Lung                            Lung



         •    The 5 year survival rate was 47% for heart-lung
              transplants and 42% for lung transplantation in
              1994/1995.




      Statistics were prepared by UK Transplant from the National Transplant Database maintained on behalf of transplant
     services in the UK and Republic of Ireland. UK Transplant is a Special Health Authority established in 1991. See their
       web site for more details: www.uktransplant.org.uk. Our thanks to UK Transplant for permission to use their data.

								
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