Chest
Volume 86, Issue 6, December 1984, Pages 824-829
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Clinical Investigations
Post-Transplant Obliterative Bronchiolitis and Other Late Lung Sequelae in Human Heart-Lung Transplantation

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Since March 1981, 19 patients have undergone heart-lung transplantation for end-stage pulmonary vascular disease, with 14 long-term survivors. In five of the survivors, obstructive airway disease has developed with the superimposition of a progressive restrictive ventilatory defect in three of them. None of these five patients showed a tendency for spontaneous improvement of flow rates. Biopsy and postmortem material was available in four of the five patients and showed obliterative bronchiolitis (OB) in three. A fourth patient showed clinical and physiologic data consistent with obliterative bronchitis, but histologic material was not available. Obstructive lung disease without restrictive features developed in a fifth patient, but no histologic evidence of OB was found at transbronchial biopsy. In addition to OB, recurrent lung infections were found in all patients, significant pleural fibrosis in two patients, and bronchiectasis in one patient Despite these long-term sequelae of human heart-lung transplantation, ten of the 14 surviving patients are leading relatively normal lives.

Section snippets

Case 1

This 30-year-old man suffered from Holt-Oram syndrome (ventricular septal defect, atrial septal defect and skeletal abnormalities). Immediate postoperative recovery was complicated by mediastinal hemorrhage which required exploration on two occasions to tie off bleeding vessels in the posterior mediastinum. Impaired movement of the left hemidiaphragm associated with left lower lobe atelectasis and infection required bronchoscopy and removal of mucous plugs on postoperative day 9, and he made a

Discussion

The introduction of innovations into clinical management presents major problems with the assessment of risks vs benefits for individual patients. Not only are there the obvious problems of predicting potential benefits and the existence of predictable risks, but the problem of unexpected long-term risks also exists.2, 3

This has proved to be the case with human heart-lung transplantation. Many of the potential benefits have materialized. Approximately two thirds of a group of terminally ill

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