immunology allergic disorders
Lung and Heart Lung Transplantation
Prognosis for Lung and Heart Lung Transplantation
Patient survival rates are At 1 year: 84% with living-donor grafts and 83% with deceased-donor grafts At 5 years: 34% with living-donor grafts and 46% with deceased-donor grafts Mortality rate is higher for patients with primary pulmonary hypertension, idiopathic pulmonary fibrosis, or sarcoidosis and lower for those with COPD or alpha-1 antitrypsin deficiency. Mortality rate is higher for single lung transplantation than for double. Most common causes of death are Within 1 month: Primary graft failure, ischemia and reperfusion injury, and infection (eg, pneumonia) excluding cytomegalovirus Between 1 month and 1 year: Infection After 1 year: Obliterative bronchiolitis Mortality risk factors include cytomegalovirus mismatching (donor positive, recipient negative), human leukocyte antigen (HLA-DR) mismatching, diabetes, and prior need for mechanical ventilation or inotropic support. Uncommonly, the original disorder, particularly some interstitial lung disorders, recurs. Such recurrence impairs exercise capacity slightly because of a hyperventilatory response. Withheart-lung transplantation,overall survival rate at 1 year is about 80% for patients and grafts. 