Heart and lung transplantation in the United States, 1996-2005.

This article examines the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients data on heart and lung transplantation in the United States from 1996 to 2005. The number of heart transplants performed and the size of the heart waiting list continued to drop, reaching 2126 and 1334, respectively, in 2005. Over the decade, post-transplant graft and patient survival improved, as did the chances for survival while on the heart waiting list. The number of deceased donor lung transplants increased by 78% since 1996, reaching 1407 in 2005 (up 22% from 2004). There were 3170 registrants awaiting lung transplantation at the end of 2005, down 18% from 2004. Death rates for both candidates and recipients have been dropping, as has the time spent waiting for a lung transplant. Other lung topics covered are living donation, recent surgical advances and changes in immunosuppression regimens. Heart-lung transplantation has declined to a small (33 procedures in 2005) but important need in the United States.

Development of the new lung allocation system in the United States.

This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities.

The Loyola University lung transplant experience.

BACKGROUND: We reviewed our experience with isolated lung transplantation at Loyola University Medical Center, Maywood, Ill. From April 1990 through June 1992, 33 lung transplantations for end-stage pulmonary disease were performed (30 single lung, three bilateral single lung). Recipient diagnoses include chronic obstructive pulmonary disease, alpha 1-antiprotease deficiency, pulmonary fibrosis, primary pulmonary hypertension, Eisenmenger's syndrome, sarcoidosis, cystic fibrosis, bronchiectasis, and bronchiolitis obliterans. METHODS: For patients who underwent transplantation for end-stage obstructive airway disease, we retrospectively reviewed functional indexes before and after transplantation. In addition, the overall survival rate was determined. RESULTS: Successful transplantation resulted in a marked improvement in functional capacity. Single-lung transplantation for end-stage obstructive airway disease resulted in a threefold improvement in the 1-second forced expiratory volume, from 0.49 to 1.64 L. The actual survival for all isolated lung transplant recipients (including both single-lung and bilateral single-lung procedures) was 73%, with a 15% 30-day mortality. CONCLUSION: Isolated lung transplantation can significantly improve functional capacity as well as the quality of life in patients with end-stage lung disease.