Lung and Heart-lung Transplantation. 2002/2

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Lung and heart-lung transplants were first successfully completed two decades ago. Since then they have been 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 life.

This factsheet presents data from the National Transplant Database on heart-lung and lung transplants in the UK and the Republic of Ireland since 1991, published by UK Transplant (see footnote).

Trends

Heart-lung transplants were the first to be implemented, initially in cases where there was pulmonary vascular 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 transplanted.

Figure 1:Numbers of heart-lung and lung transplants in UK and Ireland

There were 1632 heart-lung and lung transplants from 1991 to 2001, of which two-thirds were lung transplants. There has been no clear trend over the period with between 125 and 169 transplants being carried out each year.
The highest number of heart-lung transplants during this period was 78 in 1991. Over recent years the number has been about 50 per year.
In contrast, the number of lung transplants increased from 73 in 1991 to a peak of 116 in 1996. Since then numbers have been stable at around 100 per year.

Cause of death of donor

Eighteen percent of all donors' lungs were utilised for lung transplantation in the period 1996-2001.

Figure 2:Trend in cause of death in lung donors in UK and Ireland

The main cause of death of donors for whom lungs have been retrieved was intracranial causes (which includes intracranial bleeding) though patterns have changed over time. As Road Traffic Accidents (RTA) have fallen due to improvements in safety, so too have the number of lungs retrieved from RTAs. These fell from 316 in the period 1989-95 (a third of lungs retrieved) to 182 in 1996-2001 (a fifth). At the same time lungs retrieved from deaths due to intracranial causes rose moderately increasing the proportion of these deaths from 46% to 56% while the number (and proportion) of deaths for other causes has remained stable.

Age

Figure 3:Recipient and donor age in heart-lung and lung transplants

Heart-lung transplants were carried out in people aged up to 55 years. Fifteen percent of heart-lung transplants and four percent of lung transplants in recent years were in the under 18s. Single / double lung transplants were carried out in an older range of patients from teenagers to the over 65s.
Donors were younger than recipients with the under 18s providing 28% of heart-lung and 11% of lung transplant donors. Twenty-three percent of heart-lung and fifteen percent of lung transplants were from donors from an older age band (not shown).

Primary diasease of the recipient

Between 1997 and 2001 heart-lung transplants were most often carried out in those with cystic fibrosis (45%) and primary pulmonary hypertension (21%).

Figure 4:Primary disease of heart/lung recipient

Ten percent of recipients suffered from Eisenmenger's syndrome, a congenital heart problem that leads to pulmonary hypertension.

Figure 5:Primary disease of lung only recipient

Recipients of lung transplants in the same period included those with emphysema (33%), a fibrosing lung disease (23%), cystic fibrosis (19%) or a congenital heart/lung disease (15%).

Survival

From the time of the operation and for the rest of their lives patients must take immunosuppressive medications to try to suppress rejection of the transplanted graft. Graft rejection is common within the first 3-6 months post transplantation. During this period immunosuppressive therapy is intense leading to increased risks of serious infections. After the first year the main causes of death are infection and bronchiolitis obliterans, an obstructive lung disease.

Figure 6:Estimates of percentage surviving heart-lung and lung only transplants

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 transplants. The 1, 3 and 5 year survival rate estimates for heart-lung transplants were 69%, 59% and 47% respectively. Survival estimates for lung transplantation were comparable at 76%, 57% and 42%.

Summary

• During 1991-2001 there were 538 heart-lung and 1094 lung transplants in the UK and the Republic of Ireland.

• In 1989 to 1995, 33% of lung donors were from Road Traffic Accidents compared to 21% in 1996 -2001.

• Heart-lung transplants were most commonly carried out in those with cystic fibrosis and pulmonary hypertension.

• The most common reasons for a lung only transplant were emphysema, fibrosing lung disease and cystic fibrosis.

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

Footnote

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. Our thanks to UK Transplant for permission to use their data.