The main clinical problems that follow
heart-lung transplantation are opportunist
infections of the lungs and pulmonary rejection. Of 23 patients undergoing
heart-lung transplantation, eight had opportunist
infections and 12 had at least one episode of pulmonary rejection. Cardiac rejection occurred in only one patient, who did not need treatment. Of the 12 patients who had pulmonary rejection, nine recovered fully after augmented immunosuppression with high dose
corticosteroids, although one patient required additional low dose
corticosteroids for eight months before making a full recovery. Fatal opportunist lung
infection followed treatment for rejection in two patients. One patient developed obliterative
bronchiolitis. Of the eight patients with opportunist
infections, five had primary cytomegalovirus
pneumonitis, acquired from the donor. All three patients treated with
acyclovir died, whereas the two treated with hyperimmune
globulin and dihydroxy proxymethylguanine recovered fully. Two patients developed
Pneumocystis carinii pneumonia, which was treated successfully in one patient with intravenous sulphadimidine and
trimethoprim. The other patient died after a further episode of rejection and aspergillus
bronchitis. One patient developed a
tuberculous empyema. The calculated actuarial survival at one year was 78% and at two years 67.2%. Although it is still in its innovative stage
heart-lung transplantation appears to have complications and results similar to those of
transplantation of other organs.