Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry.

OBJECTIVE: Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Switzerland, the first lung transplant was performed in November 1992, more than ten years after the first successful procedure world-wide. Thenceforward, a prospective national lung transplant registry was established, principally to enable quality control. PATIENTS: The data of all patients transplanted in the two Swiss Lung Transplant centres Zurich University Hospital and Centre de Romandie (Geneva-Lausanne) were analysed. RESULTS: In 10 years 242 lung transplants have been performed. Underlying lung diseases were cystic fibrosis including bronchiectasis (32%), emphysema (32%), parenchymal disorders (19%), pulmonary hypertension (11%) and lymphangioleiomyomatosis (3%). There were only 3% redo procedures. The 1, 5 and 9 year survival rates were 77% (95% CI 72-82), 64% (95% CI 57-71) and 56% (95% CI 45-67), respectively. The 5 year survival rate of patients transplanted since 1998 was 72% (95% CI 64-80). Multivariate Cox regression analysis revealed that survival was significantly better in this group compared to those transplanted before 1998 (HR 0.44, 0.26-0.75). Patients aged 60 years and older (HR 5.67, 95% CI 2.50-12.89) and those with pulmonary hypertension (HR 2.01, 95% CI 1.10-3.65) had a significantly worse prognosis The most frequent causes of death were infections (29%), bronchiolitis obliterans syndrome (25%) and multiple organ failure (14%). CONCLUSION: The 10-year Swiss experience of lung transplantation compares favourably with the international data. The best results are obtained in cystic fibrosis, pulmonary emphysema and parenchymal disorders.

[Lung transplantation results: does a learning curve exist?]. / Résultats après transplantation pulmonaire: existe-t-il une courbe d'apprentissage?

Lung transplantation is an established procedure for end-stage non malignant respiratory disorders. Lung transplantation involves multidisciplinary skills and expertise and one can question the ability of small units to achieve successfully such a demanding therapy. We report here the results from the Lausanne unit of the Geneva-Lausanne lung transplantation center. We have compared the 1993 to 1996 and the 1997-2000 period. For the 29 lung transplantions performed the actuarial survival was 75% at 3 years and 72% at 5 years. There was no significant difference in survival or in functional status between the two periods. We conclude that despite the small number of patients treated, these results compare favourably with published international data. In particular, no learning curve effect was observed.