Successful Heart-lung Transplantation Research Articles

Combined heart–lung transplantation from a donation after circulatory death donor

Combined heart-lung transplantation is the optimal treatment option for many patients with end-stage heart failure and fixed severe pulmonary hypertension. It offers the only possibility of long-term survival and a return to a normal quality of life. Unfortunately, it is rarely performed because of donor organ allocation policies. We present the case of a critically ill 24-year-old man, who after waiting for >100 days in-hospital on the urgent transplant list, deteriorated further and underwent the first successful heart-lung transplant with organs from a donation after circulatory death.

An 18-year follow-up after the first successful heart-lung transplant in Poland. Authors' tribute to the pioneers of heart and lung transplantation.

An 18-year follow-up after the first successful heart-lung transplant in Poland. Authors' tribute to the pioneers of heart and lung transplantation.

Successful Combined Heart-Lung Transplant from a Donation after Circulatory Determined Death (DCD) Donor

For patients with end stage heart failure and fixed pulmonary hypertension, combined heart-lung transplantation offers the only possibility of survival with a return to a normal quality of life. Unfortunately, due to the severe scarcity of donation after brain death (DBD) organs it is rarely performed. We present the first successful combined heart lung transplant from a DCD donor. A 24-year-old male born with transposition of the great arteries, pulmonary stenosis and a ventricular septal defect (VSD) was operated in childhood with the arterial switch operation and closure of VSD. He continued to suffer with pulmonary hypertension in childhood treated with pulmonary vasodilators. He was referred to our institute in decompensated heart failure and listed for combined heart and lung transplantation, (table 1). After 3 months on the urgent list with no suitable DBD donor offers, the possibility of DCD transplantation was discussed. He matched for a DCD heart-lung bloc 109 days after his original listing and 17 days after listing for a DCD organ. The donor was a 29 year old male motorcyclist who suffered a 30 minute hypoxic cardiac arrest following a road traffic accident (table 1). The potential donor was treated for Staphylococcus aureus pneumonia and was ventilated for 12 days in ITU until futility was declared. Death was declared 219 minutes following withdrawal with a functional warm ischaemic time of 41 minutes. The heart heart and lungs were removed en bloc and perfused together on an in house modified Transmedics OCS lung device for 8 hours 2 minutes. Post transplant the recipient weaned off cardiopulmonary bypass without difficulty. He was discharged home in the 7th post-operative week and remains well at home 3 months following his transplant. DCD heart-lung transplantation has the potential for the increasing number of young adult congenital heart failure patients bridged through childhood with palliative surgical procedures in urgent need of transplantation.

Successful Heart-Lung Transplant for a Patient on Continuous-Flow Left Ventricular Assist Device Support Complicated With Amiodarone-Induced Pulmonary Fibrosis

In this case report, we present a successful case of en bloc heart-lung transplant in a patient with advanced cardiopulmonary respiratory failure from amiodarone-associated pulmonary fibrosis that occurred post-left ventricular assist device implantation.

History of lung transplantation.

Lung transplantation nowadays is a well-accepted and routine treatment for well selected patients with terminal respiratory disease. However, it took several decades of experimental studies and clinical attempts to reach this success. In this paper, we describe the early experimental activity from the mid-forties until the early sixties. The first clinical attempt in humans was reported by Hardy and Webb in 1963 followed by others with short survival only except for one case by Derom et al. who lived for 10 months. Long-term successes were not reported until after the discovery of cyclosporine as a new immunosuppressive agent. Successful heart-lung transplantation (HLTx) for pulmonary vascular disease was performed by the Stanford group starting in 1981 while the Toronto group described good outcome after single-lung transplantation (SLTx) for pulmonary fibrosis in 1983 and after double-lung transplantation for emphysema in 1986. Further evolution in surgical techniques and in transplant type for the various forms of end-stage lung diseases are reviewed. The evolution in lung transplantation still continues nowadays with the use of pulmonary allografts coming from living-related donors, from donors after circulatory death, or after prior assessment and reconditioning during ex vivo lung perfusion (EVLP) in an attempt to overcome the critical shortage of suitable organs. Early outcome has significantly improved over the last three decades. Better treatment and prevention of chronic lung allograft dysfunction will hopefully result in further improvement of long-term survival after lung transplantation.

Outcome of the First Successful Heart-Lung Transplantation in the Baltic Countries

Successful heart-lung complex transplantation was performed in a 48-year-old man. During the postoperative period, M. tuberculosis infection was diagnosed, and the treatment subsequently started. One year after, the patient was urgently hospitalized due to myocardial infarction. However, despite the best efforts, the patient died. Antituberculosis treatment is recommended to all the patients with confirmed active tuberculosis. Treatment of tuberculosis in transplant recipients is similar to that of the general population, with the exclusion of rifamycins in the regimen and longer duration of treatment.

The first successful heart–lung transplantation in Japan: report of a case

Although legislation regarding organ transplantation from brain-dead donors in Japan was approved in 1997, no heart-lung transplantation procedures were performed for some time. Herein, we report the first case of successful heart-lung transplantation in Japan. The recipient was a 35-year-old man with Eisenmenger syndrome, caused by a double outlet right ventricle, who had been suffering hemoptysis and continued NYHA class 3-4 symptoms for 66 months since being registered on the waiting list. He underwent heart-lung transplantation from a 30-year-old donor. The organ ischemic time was 247 min, the postoperative course was uneventful, and the patient was discharged 66 days after the transplant surgery.

Heart–Lung Transplantation in a 14-year-old Boy With Alström Syndrome

We present a 14-year-old boy who suffered from progressive biventricular cardiac failure and secondary pulmonary artery hypertension associated with the rarely seen Alström syndrome. The boy underwent successful heart-lung transplantation. We conclude from this report that heart-lung transplantation in patients with Alström syndrome is a viable therapeutic option in select cases.

Cardiac Transplantation in a Patient With Effective Single Left Lung Physiology

Cardiac Transplantation in a Patient With Effective Single Left Lung Physiology

Successful heart–lung transplantation in a patient with kyphoscoliosis

The association is well established between congenital heart disease and spinal deformities such as scoliosis or kyphosis, but data are not available for risks and the outcome of heart surgery in patients with spinal deformities. We report a case of successful orthotopic heart lung transplantation in a patient with complex congenital heart disease and severe chest deformity who had undergone previous spinal fusion surgery for progressive right convex thoracic kyphoscoliosis.

Exercise after lung transplant

Lung transplantation has evolved into the standard treatment for selected patients with severe end-stage pulmonary and pulmonary–vascular disease. In the two decades since the first successful heart–lung transplant in 1981, there has been a substantial improvement in early mortality. Many heart–lung and bilateral lung transplant recipients achieve near normal lung function. Despite a significant improvement in maximal exercise capacity after lung transplantation with VO2 peak increasing to the range of 40 to 60% predicted, this remains well below normal values. Ventilatory limitation to exercise does not appear to contribute to impaired exercise capacity in those subjects with normal graft function and generally reflects the presence of complications in the allograft (for example, bronchiolitis obliterans). The evidence points toward a pretransplant injury resulting in impairment of skeletal muscle oxidative capacity with subsequent further injury after transplantation, particularly related to immunosuppressant drugs such as corticosteroids and cyclosporin A, resulting in significant peripheral limitation to exercise.

First successful heart-lung transplantation for cystic fibrosis in Israel

First successful heart-lung transplantation for cystic fibrosis in Israel

Lung Transplantation in Cystic Fibrosis: Consensus Conference Statement

The first successful heart-lung and lung transplant operations in cystic fibrosis (CF) patients were performed in 1983 and 1987, respectively. Lung transplantation is now available at dozens of centers in North America, Europe, and Australia. Recent technical developments and the major limitations of donor organ availability prompted the CF Foundation to sponsor a meeting of 37 experts to evaluate the state of the art in lung transplantation for CF, highlighting areas of consensus, practice variations, and controversy. This document summarizes the work of that group.

Heart-lung transplantation in a patient with pulmonary atresia and ventricular septal defect

Operation for pulmonary atresia and ventricular septal defect is challenging, as in most patients the pulmonary arteries are hypoplastic, nonconfluent, or in part absent. In these cases, combined heart-lung transplantation may be the surgical treatment of choice. In the described case, the morphology of pulmonary atresia and ventricular septal defect was present in combination with completely atretic main, left, and right pulmonary arteries. In this patient, successful heart-lung transplantation was performed.

Technique of combined heart-lung transplantation.

Heart-lung transplantation was, for many years, conceptualized as a possible treatment for patients with combined end-stage cardiac and pulmonary disease. As experience grew with heart transplantation, particularly in the 1970s, the difficulties of performing the orthotopic operation in patients with fixed pulmonary hypertension became apparent. This further impetus for combined heart-lung transplantation led to successful animal experiments in the late 1970s, and the first successful heart-lung transplant operation was performed in 1981. There has been significant evolution in the operative technique for the recipient operation, with emphasis on preservation of the phrenic, vagal, and recurrent laryngeal nerves and on meticulous hemostasis, with particular attention to the bronchial vessels of the posterior mediastinum. Donor procurement is of critical importance to the success of the operation, and criteria for donor selection have been well established. Lung preservation remained, for many years, a significant limitation, but current techniques involving the use of prostaglandin E1 have led to safe distant procurement with ischemic times up to 6 hours. The heart-lung transplant operation remains an effective modality for the treatment of patients with congenital heart disease, primary pulmonary hypertension, chronic obstructive pulmonary disease, and cystic fibrosis.

I'll Take Tomorrow: The Story of a Courageous Woman Who Dared to Subject Herself to a Medical Experiment—The First Successful Heart-Lung Transplant

ABSTRACT I'll Take Tomorrow is the fascinating autobiographical story of Mary Gohlke, the first long-term survivor of a heart-lung transplant. It is the chronicle of her discovery that she was dying of primary pulmonary hypertension and of the day-to-day events leading up to and following her historic operation. The author—wife, mother, and advertising executive— shares her physical, emotional, and mental struggle with the fantastic problems that are associated with successful cardiopulmonary transplantation, from organ rejection to behavioral disturbances and the need to readjust to family relationships and employment.Faced with the choice between certain death and another chance for life, Gohlke chose to subject herself to a dramatic experimental procedure. During her journey back to health, her optimism gave way at times to anxiety, despair, and even depression. Her moving account reminds us of just how taxing living with a transplanted organ can be. The book is filled with emotion and