Yacoub M H, Banner N R, Khaghani A, Fitzgerald M, Madden B, Tsang V, Radley-Smith R, Hodson M
Cardiothoracic Unit, Harefield Hospital, Middlesex, U.K.
J Heart Transplant. 1990 Sep-Oct;9(5):459-66; discussion 466-7.
Between September 1984 and October 1988, 27 patients underwent combined heart-lung transplantation for treatment of end-stage respiratory disease caused by cystic fibrosis. The actuarial patient survival was 78% at 1 year and 72% at 2 years. Bacterial respiratory infections were common in the early postoperative period and necessitated vigorous medical therapy. The dose of cyclosporine required in these patients was higher than in conventional transplant recipients, and this contributed to an increased cost of postoperative care. Lung function was greatly improved after transplantation, and long-term survivors achieved an excellent quality of life. Lymphoproliferative disorders developed in two patients; these disorders regressed after a reduction in immunosuppression. Two patients required retransplantation: one because of obliterative bronchiolitis and the other because of recurrent respiratory infections associated with a moderate tracheal stenosis and severe deterioration in lung function. A modification of the technique used for heart-lung transplantation allowed 20 hearts from cystic fibrosis patients to be used for subsequent heart transplantation. Immediate heart function was satisfactory in all cases. The actuarial survival of the recipients of these domino heart transplants was 75% at 1 year. No coronary artery disease was present in the 12 patients who have undergone coronary angiography at 1 year.
1984年9月至1988年10月期间，27例患者接受了心肺联合移植，以治疗囊性纤维化所致的终末期呼吸系统疾病。患者1年实际生存率为78%，2年为72%。术后早期细菌呼吸道感染很常见，需要积极的药物治疗。这些患者所需的环孢素剂量高于传统移植受者，这导致术后护理成本增加。移植后肺功能有很大改善，长期存活者生活质量良好。两名患者发生了淋巴增生性疾病；免疫抑制降低后这些疾病消退。两名患者需要再次移植：一名是因为闭塞性细支气管炎，另一名是因为与中度气管狭窄和肺功能严重恶化相关的反复呼吸道感染。对用于心肺移植的技术进行的改进使得20颗来自囊性纤维化患者的心脏能够用于后续的心脏移植。所有病例中即刻心脏功能均令人满意。这些多米诺心脏移植受者1年实际生存率为75%。在1年时接受冠状动脉造影的12例患者中未发现冠状动脉疾病。
