Combined Heart and Lung Transplantation - A Retrospective Analysis of 27 Years at the Klinikum Grosshadern

Objectives: Combined heart and lung transplantation was done throughout the past decades for a variety of end-stage failure of either the heart or the lung leading to secondary failure of the other organ. Here, we present the experience of a 27 year period at our center in Munich.

Methods: Between 1983 and 2010, a cohort of 80 consecutive patients received combined heart and lung transplantation at the Klinikum Grosshadern. A retrospective data analysis was performed regarding overall survival and graft function. Further, co-morbidities as renal and liver function were evaluated.

Results: Main indications for combined heart and lung transplantation were primary pulmonary hypertension (37.5%) followed by ventricular septal defect (16.3%) and pulmonary atresia (12.5%). Mean age at transplantation was 29.1 ± 1.5 years with 43 patients (54%) being females. Immunosuppressive regimen varied throughout the years with tacrolimus, mycophenolate and prednisolone being the most common (in 56.7% of cases). Mean survival was 77.3 ± 9.2 months with 26 patients (32.5%) being still alive at the end of the observation period. One, five and ten year survival was 61.1%, 53.4% and 33.5% respectively. While pulmonary function decreased by time, heart function could be preserved. Renal function remained stable with intermittent haemodialysis being necessary in 25 patients (32.9%). Nine patients were listed for second organ transplantation.

Conclusion: Outcome after combined heart and lung transplantation at our center is comparable to the international registry data. Considering on one hand the dramatic organ shortage and on the other hand novel therapeutic strategies in thoracic transplantation, this procedure remains a beneficial therapeutic option, however, only in carefully selected patients.