We report outcomes of a large UK cohort of adult Cystic Fibrosis(CF) patients undergoing bilateral sequential lung transplantation(BLT) at a single institution.
Methods and Materials
We searched our prospectively maintained database for patients undergoing lung transplantation (LT) for CF between 01/89-11/12. Survival was censored at 7/11/12. A unified approach to BLT has been undertaken in these patients. Including targeted antibiotic prophylaxis, pleural cavity and central airway taurolidine irrigation, surgery (clamshell incision) on full cardiopulmonary bypass (CPB) (off-pump or extra-corporeal membrane oxygenation (ECMO) not used), bilateral pneumonectomy prior to donor implant and synchronous controlled reperfusion. Since 12/07, a genomovar specific policy has been adopted and patients colonized with Burkholderia cenocepacia have been excluded from LT.
A total of 270 LT for CF were performed during this period. Included in this were two single lungs (with synchronous pneumonectomy), one living donor lobar transplant, four heart-lung (pre-1990) and two lung-liver. Of the 261 remaining, 253 were performed in adults (cohort analyzed). There were 118 (47%) males, median (range) age 27.4 (16.5-32.7) years. Mean [95%CI] BMI at assessment was 19.6 [19.2-19.9]. Median time to transplantation from listing was 305 (4-2190) days. Median ischemic time was 340 (131-601) mins. Survival at 1, 3, 5 and 10 years was 83%, 74%, 65% and 53%. There was a trend to improved late survival for patients transplanted post vs. pre-2000; 84 vs. 79%, 76 vs. 68%, 67 vs. 58% and 56 vs. 45% (p = 0.106).
In this large single centre experience of BLT for CF, our institutional operative strategy utilizing full CPB(not ECMO) for all cases, with recipient bilateral pneumonectomy prior to implantation simplifies airway management, virtually eliminates pleural spillage and excludes possible spillage from recipient to donor lung. Our standardized and simplified approach yields excellent and improving results in this challenging group of patients.