Editorials

Immunosuppressive drugs after lung transplantation

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7133.719 (Published 07 March 1998) Cite this as: BMJ 1998;316:719

New agents may improve long term survival

  1. Norman Briffa, Research fellow,
  2. Randall E Morris, Director
  1. Laboratory for Transplantation Immunology, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5247, USA

    Survival figures after lung transplantation for the period up to 1996 were reported at a recent annual meeting of the International Society of Heart and Lung Transplantation in London. Although quality of life for patients is greatly improved for some years after transplantation, five year survival after heart-lung, single lung, or double lung transplantation is still less than 50%.1 Mortality in the first 30 days has improved because of advances in surgical technique and in methods of lung preservation,1 but after 30 days the survival curves in 1988-91 and in 1992-5 are parallel.

    The main cause of death between 30 days and a year after transplantation is infection. After a year the main cause is bronchiolitis obliterans syndrome. This fibroproliferative disorder affects the small airways of at least half of patients who survive for three months after transplantation.2 Its pathogenesis is unclear but it represents a fibrotic repair process occurring after chronic airway injury, and retrospective series have shown that …

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