Cardiopulmonary Transplantation: Experience of A Lung Transplant Group P. Morales, L. Almenar, J.J. Torres, A. Sole ´ , R. Vicente, F. Ramos, P. Morant, C. Lozano, V. Calvo, for the Valencia Lung Transplant Group ABSTRACT Cardiopulmonary transplantation (CPT) is indicated for patients eligible for heart transplantation (HT) or lung transplantation (LT) who have severe concomitant lung or heart disease. Only 2 groups perform CPT in Spain. We report our experience with 18 CPTs representing 8.2% and 5% compared with LT (220) and HT (362), respectively, from February 13, 1990 to October 15, 2002. The mean time on a waiting list was 138 days. The current number of surviving patients is 7 (39%), with a mean follow-up of 602 days (range, 3 to 4627 days). They all remain asymptomatic with normal respiratory function in 4 patients. No cardiac graft rejection has been detected. Two patients experienced sustained gastroparesis during the first year with spontaneous resolution. Death occurred within the first 3 months in 9 patients. These outcomes contrast with the early mortality associated with LT and HT in our series, namely 10.6% and 11%, respectively. The different causes of death were as follows: sepsis and multiorgan failure in 5 patients, hemorrhagic shock in 3 patients, and suture dehiscence and fungal aortic perforation in 1 patient. Late mortalities were recorded in 2 cases. Overall patient survival in our series is lower than that reported by the International Registry (IR), with an early mortality rate of 50% (30% IR). Nevertheless, our survival rate at 10 years after transplantation is 30% (26% IR). We conclude that CPT should be considered despite the greater early morbidity and mortality. S PECIALIZATION by some groups in cardiopulmonary transplantation (CPT) has lead to this being the pro- cedure of choice for end-stage pulmonary diseases. 1–4 The disease responsible for the largest number of transplanta- tions has been cystic fibrosis, for en bloc CPT. 3,4 CPT is currently indicated for patients eligible for lung transplan- tation (LT) who have severe concomitant heart disease, or for patients eligible for heart transplantation (HT) with pulmonary hypertension (PHT) or severe pulmonary dis- ease. 5–9 Only 2 groups currently perform CPT in Spain. We report our experience and results with this type of trans- plantation. MATERIALS AND METHODS The period analyzed covers the interval from the first CPT, performed on February 13, 1990, to October 15, 2002. The following parameters have been analyzed: number of procedures and percentages of LT and HT compared with the total number, age and sex distribution, clinical indication, mean time on the transplant waiting list, history, immunosuppression, and subse- quent clinical course. RESULTS The 18 CPTs represented 8.2% and 5% compared with LT (220) and HT (362), respectively. The mean patient age was 38  11 years (range, 13 to 54 years). There were 11 men and 7 women. In 10 patients, the clinical indication was essentially cardiac disease: cardiomyopathy in 3 cases (1 each associated with bronchiectasis and emphysema), trun- cus-type heart disease in 1 case, coronary artery disease in 2 cases (associated with primary PHT in 1 patient and with lung fibrosis in another), and Eisenmenger syndrome in 4 cases. In the remaining 8 patients the indication was mainly lung disease: primary PHT in 3 cases with a reduced right ventricular ejection fraction (RVEF 25%), and advanced From the Departments of Pneumology (P.M., J.J.T., A.S.), Cardiology (L.A.), Anesthesia and Resuscitation (R.V., F.R.), Respiratory Rehabilitation (P.M., C.L.) and Chest Surgery (V.C.) La Fe University Hospital, Valencia, Spain. Address reprint requests to Pilar Morales, Servicio de Neumo- logia, Hospital Universitario La Fe, Avda. Campanar 21, 46009 Valencia, Spain. E-mail: pila1460@separ.es 0041-1345/03/$–see front matter © 2003 by Elsevier Inc. All rights reserved. doi:10.1016/S0041-1345(03)00712-7 360 Park Avenue South, New York, NY 10010-1710 1954 Transplantation Proceedings, 35, 1954 –1956 (2003)