Follow up and comparison of Icelandic and Swedish Lung Transplant patients in the years 2010-2012

Abstract

Introduction: Lung transplantation is a valid treatment for end stage lung disease. The most common indication is chronic obstructive pulmonary disease and the second is idiopathic pulmonary fibrosis. There is a thorough process before a patient receives a lung transplantation. First, the patient has to be referred to a lung transplant center. Then, the patient needs to be placed on the lung transplant list. The two most important things to look at before a patient is put on the transplant list are (1) will he survive the surgery and (2) how long will he survive after the surgery. There are numerous problems that lungtransplant patients face. These problems arise from the medication and rejection of the lung allograft. The treatment is centered on immunosuppression with the aim of delaying the development of BOS. The treatment is also aimed at reducing the occurrence of factors that increase the likelihood of developing BOS, such as CMV infection and acute infection.Methods and material: Information from 10 Icelandic patients and 20 Swedish patients was collected at the National Hospital of Iceland and at Sahlgrenska University Hospital in Sweden. The information collected included four years of follow up and the values before the transplant for lung function and plasma clearance. Additional information collected included the number of patients with BOS, occupation, different types of lungs received, CMV status, survival, how many received a CMV treatment, and how many CMV treatments were prescribed.Results: Looking at the follow up of lung function and kidney function, the patients seem to be stable and doing well. There is a major increase in lung function values after the surgery, but after that the patients have relative constant lung function values, on average. In comparing the patient groups for lung function, there was one major difference—Sweden was doing much better. Iceland had a higher rate of survival than Sweden, but Iceland had higher levels of BOS.Conclusion: Both patient groups seem to be benefitting from the transplants, since both groups have an average increase in the lung function values FEV1 and FVC and on average do not have a clinical manifestation of kidney disease according to the plasma clearance levels. The main difference between Iceland and Sweden was the difference in lung function values; this seems to have occurred because Sweden‘s COPD patients received larger lungs than Iceland‘s COPD patients; however, the difference in reference values also plays a part. The sample population evaluated for this study was very small, so any difference in the two patient groups requires further research.