An overview of lung transplantation in Korea.

OBJECTIVE: Lung transplantation (LTx) is the only option for end-stage lung disease refractory to medical treatment. The program was slow to start in Korea; the first LTx was performed in July 1996. By October 2007, 25 lung and 7 heart-lung transplantations have been performed at 5 institutes, with the majority being performed at one center. The aim of this study was to improve the survival rate following LTx by analyzing the operative procedure and its complications.

METHODS: We performed a retrospective review of the medical records of 18 patients who underwent lung and heart-lung transplantations from July 1996 to October 2007 at a single institute. Operative mortality was excluded from the analysis of early and late complications.

RESULTS: There were 12 males and 6 females of mean age 46.2 +/- 11.5 years (range, 25-63 years). The indications for transplantation included pulmonary emphysema (n = 6), idiopathic pulmonary fibrosis (n = 3), lymphangioleiomyomatosis (n = 3), Eisenmenger's syndrome (n = 2), bronchiectasis (n = 2), primary pulmonary hypertension (n = 1), and primary graft dysfunction after a single lung transplantation (SLT; n = 1). Operations consisted of SLTs in 9 patients, bilateral sequential single lung transplantations (BSSLTs) in 8 patients, and a heart-lung transplantation (HLT) in 1 patient. Early complications were bleeding necessitating rethoracotomy, severe reperfusion injury, seizure, prolonged airleak, chylothorax, and pulmonary artery stenosis. Late complications consisted of cytomegalovirus infection, pulmonary tuberculosis, posttransplantation lymphoproliferative disease, gastric ulcer perforation, pneumothorax, chylothorax, empyema, and aspergillosis. There were 5 operative deaths due to intraoperative bleeding (n = 1), acute graft dysfunction (n = 2), and multiorgan failure (n = 2). Excluding the operative mortality, the mean survival period was 18.5 +/- 23.7 months (range, 3-87 months).

CONCLUSIONS: Clinical experience in recent years may have reduced complication rates and led to prolonged survival. Increasing the candidate list through better results and raising awareness of the LTx program is necessary to move forward with thoracic transplantation in Korea.