Lung transplantation for cystic fibrosis: effective and durable therapy in a high-risk group Thomas M Egan, MD, Frank C Detterbeck, MD, Michael R Mill,

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Presentation transcript:

Lung transplantation for cystic fibrosis: effective and durable therapy in a high-risk group Thomas M Egan, MD, Frank C Detterbeck, MD, Michael R Mill, MD, Kristi K Gott, RN, Jean B Rea, RN, Judy McSweeney, RN, Robert M Aris, MD, Linda J Paradowski, MD The Annals of Thoracic Surgery Volume 66, Issue 2, Pages 337-345 (August 1998) DOI: 10.1016/S0003-4975(98)00496-2

Fig 1 (A) The “clamshell” or bilateral thoracosternotomy incision for bilateral lung transplantation. (Reprinted with permission from Egan TM, Detterbeck FC. Techniques of lung transplantation. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of cardiothoracic surgery. New York: Lippincott-Raven, 1998:167–77.) (B) This incision affords excellent exposure of both pleural spaces as well as exposure of the pericardial sac and its contents. The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)

Fig 2 (A) Exposure through the clamshell incision allows for cannulation for cardiopulmonary bypass (preoperatively). (B) Operative photo after implantation of both lower lobes through clamshell incision. The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)

Fig 3 Actuarial survival of 76 recipients of bilateral lung transplants for CF. Numbers in parentheses refer to the number surviving at that posttransplantation interval ± 95% confidence limits. The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)

Fig 4 Actuarial freedom from the development of bronchiolitis obliterans syndrome. Patients who died of causes other than bronchiolitis obliterans syndrome were censored at the time of their death. Numbers in parentheses refer to the number of patients with CF alive at that posttransplantation interval and without bronchiolitis obliterans syndrome, ± 95% confidence limits. The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)

Fig 5 Pulmonary function tests after double-lung transplantation for CF recipients of bilateral transplants. Numbers in parentheses refer to the number of patients with recorded pulmonary function tests at various time intervals (mean ± standard error). The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)

Fig 6 Actuarial survival for 36 recipients who had panresistant organisms (dashed line) compared with 46 recipients whose airway organisms were sensitive to at least one antibiotic on the day of transplantation (solid line) (± 95% confidence level). The Annals of Thoracic Surgery 1998 66, 337-345DOI: (10.1016/S0003-4975(98)00496-2)