From Doctor's Guide
By Roberta Friedman, PhD
SAN FRANCISCO -- October 17, 2008 -- A retrospective review of lung transplants performed in patients with idiopathic pulmonary fibrosis (IPF) at a single institution shows that patients who undergo bilateral lung transplantation with cardiopulmonary bypass gave similar survival rates as patients with single-lung transplants without bypass, and may avoid pulmonary hypertension.
The findings were presented here on October 14 by John Richards Frederick, MD, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
IPF is not medically treatable, and median survival is 3 years, according to Dr. Frederick.
Use of cardiopulmonary bypass might help avoid the pulmonary hypertension associated with lung transplantation, which can increase the mortality risk in these patients.
Dr. Frederick and colleagues conducted a retrospective review of records from a total of 587 lung transplant patients at the centre from 1991 to 2007. Among 105 patients who underwent lung transplantation for IPF during the last 5 years of this period, survival rates were 89% for those with bilateral lung transplant with bypass and 79% for those who received single lung transplants without bypass, an insignificant difference (P = .3).
However, in the 10 years from 1991 to 2002, single-lung transplant patients had better survival as compared with bilateral transplants (70% vs 45%; P = .16), Dr. Frederick reported.
The decrease in postoperative pulmonary arterial pressure among patients who had bilateral lung transplants with bypass was 19.5 mm Hg compared with a 4.2 mm Hg decrease in patients who had single-lung transplants without bypass (P = .02).
"Survival of patients undergoing bilateral lung transplant has approached that of the single-lung transplant population, and postoperative reduction in pulmonary arterial pressure is likely a contributing factor," the study investigators noted.
"Bilateral transplant is becoming accepted as the technique improves," Dr. Frederick said.
[Presentation title: Impact of Bilateral Lung Transplantation and Cardiopulmonary Bypass on Survival in Patients With Idiopathic Pulmonary Fibrosis. Abstract S31]
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