Between December 1983 and April 1989, 222 combined heart and lung transplant operations were performed for treatment of pulmonary
vascular disease and parenchymal
lung disease at Harefield Hospital. Seventeen of these patients had
emphysema, and 11 of them were followed up for a minimum of 1 year. There were nine male and two female patients. Their mean age was 39 (range, 32 to 54) years. Seven had
alpha 1-antitrypsin deficiency. Six patients were receiving continuous
oxygen therapy, and two patients were dependent on a
ventilator. Postoperatively, the patients' lungs were ventilated for a median of 3 days (range, 24 hours to 2 weeks). Two patients subsequently required further periods of ventilation. Immunosuppression consisted of
azathioprine and
cyclosporine. Three patients also received low-dose oral
steroids. There was one early death, which occurred on the second postoperative day. The remaining patients were followed up for 12 to 53 (mean, 22) months. One patient had cytomegalovirus
pneumonitis 6 weeks postoperatively that responded to treatment. There was one late death at 14 months after reoperation for treatment of obliterative
bronchiolitis. The overall survival was 91% at 1 year. All survivors achieved an excellent level of rehabilitation. It is concluded that the medium-term results of heart and
lung transplantation for treatment of
emphysema are good and that patients with
alpha 1-antitrypsin deficiency may undergo transplant procedures without substitution
therapy.