Long-term survival after lung and heart-lung transplantation

Beyond the first post-transplant (post-Tx) year the mortality after lung (LTx) and heart-lung (HLTx) transplantation declines and only few risk factors for long-term survival overlap with hazards for 1-year mortality. We investigated the late mortality risk factors after LTx and HLTx with special attention focused on potential regional and center-specific features. Methods: In 114 adult LTx and HLTx recipients (Tx between 9/1990–9/2002) who survived the first post-Tx year we analyzed the impact of age, gender, donor-recipient interaction, indication for Tx, rejection treatments and post-Tx morbidities. Results: Survival rates after the first post-Tx year were 84% at 3 years, 67% at 5 years and 44% at 8 years. Conditional half-life was 7,1 years. Survival was better in females and also better after HLTx than after LTx (p<0,01). Survivors beyond 5 years had less cytomegalovirus (CMV) infections and acute rejections than those who died in the 1 st -5 th post-Tx year (p<0,01). Recipients younger than 30 years showed better long-term survival than the other recipient age-groups (p<0,01) but we found no survival differences between age-groups 30–55 and >55. Survival by pre-Tx diagnosis was highest for primary pulmonary hypertension and congenital heart diseases. Lowest survival rates were found for chronic-obstructive pulmonary disease and α 1 -antitrypsin-deficiency emphysema (p<0,01). Conclusions: CMV and rejections showed higher negative impact on survival than recipient age. Long-term post-LTx/HLTx survival in our patients also shows particularities related to recipient gender and indication for Tx. This suggests the usefulness of separate transplant-center or regional multi-center outcome analyses for better evaluation of late mortality risk-factors.