Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 143 No. 3334 (2013)

Zurich University Hospital lung transplantation programme: update 2012

  • Ilhan Inci
  • Mace Schuurmans
  • Annette Boehler
  • Walter Weder
Cite this as:
Swiss Med Wkly. 2013;143:w13836


Lung transplantation is an established therapeutic option for end-stage lung disease in selected patients. During the last 30 years more than 34,000 transplantations have been performed worldwide. Emphysema, pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are the most common indications. This type of surgical treatment is increasingly successful, with better early and late survival rates. However, lung transplantation is still hampered by persisting problems such as donor organ shortage, primary graft dysfunction, late graft dysfunction and morbidity related to long-term immunosuppression. The first lung transplantation in Switzerland was performed the 10th November 1992 at Zurich University Hospital. Since then the lung transplant programme has progressively increased its yearly transplant volume. Since the beginning of our lung transplantation programme, overall patient survival has increased steadily and has been at benchmark levels since the year 2000. The most important factors influencing this result are presumably good teamwork among all involved specialists, improved surgical techniques, and close and long-term patient follow-up by the transplant pulmonologists. In this paper we present our programme structure, managing strategies for some specific problems and outcome after lung transplantation. The results presented here are from recipients who underwent lung transplantation up to the end of 2011.


  1. Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update – a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006;25:745–55.
  2. Orens JB, Boehler A, de Perrot M, et al. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant. 2003;22(11):1183–200.
  3. Gabbay E, Williams TJ, Griffiths AP, et al. Maximizing the utilization of donor organs offered for lung transplantation. Am J Respir Crit Care Med. 1999;160:265–71.
  4. Straznicka M, Follette DM, Eisner MD, et al. Aggressive management of lung donors classified as unacceptable: excellent recipient survival one year after transplantation. J Thorac Cardiovasc Surg. 2002;124:250–8.
  5. Pierre AF, Sekine Y, Hutcheon MA, et al. Marginal donor lungs: a reassessment. J Thorac Cardiovasc Surg. 2002;123:421–8.
  6. Lardinois D, Banysch M, Korom S, et al. Extended donor lungs: eleven years experience in a consecutive series. Eur J Cardiothorac Surg. 2005;27(5):762–7.
  7. Weder W, Inci I, Korom S, et al. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg. 2009;35:293–8.
  8. Inci I, Weder W. Airway complications after lung transplantation can be avoided without bronchial artery revascularization. Curr Opin Organ Transplant. 2010;15(5):578–81.
  9. Schuurmans MM, Benden C, Inci I. Practical approach to early postoperative management of lung transplant recipients. Swiss Med Wkly. 2013;143:w13773.
  10. Speich R, Nicod LP, Aubert JD, et al. Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry. Swiss Med Wkly. 2004;134(1-2):18–23.
  11. Date H, Trulock EP, Arcidi JM, et al. Improved airway healing after lung transplantation. An analysis of 348 bronchial anastomoses. J Thorac Cardiovasc Surg. 1995;110(5):1424–32.
  12. Wildevuur C.R.H., Benfield J.R. A review of 23 human lung transplants by 20 surgeons. Ann Thorac Surg. 1970;9:489–515.
  13. Ruttmann E, Ulmer H, Marchese M, et al. Evaluation of factors damaging the bronchial wall in lung transplantation.J Heart Lung Transplant. 2005;24(3):275–81.
  14. Schroder C, Scholl F, Daon E, et al. A modified bronchial anastomosis technique for lung transplantation. Ann Thorac Surg. 2003;75(6):1697–704.
  15. Alvarez A, Algar J, Santos F, et al. Airway complications after lung transplantation: a review of 151 anastomoses. Eur J Cardiothorac Surg. 2001;19(4):381–7.
  16. Choong CK, Sweet SC, Zoole JB, et al. Bronchial airway anastomotic complications after pediatric lung transplantation: incidence, cause, management, and outcome. J Thorac Cardiovasc Surg. 2006;131(1):198–203.
  17. Herrera JM, McNeil KD, Higgins RS, et al. Airway complications after lung transplantation: treatment and long-term outcome. Ann Thorac Surg. 2001;71:989–93.
  18. Aigner C, Jaksch P, Seebacher G, et al. Single running suture – the new standard technique for bronchial anastomoses in lung transplantation. Eur J Cardiothorac Surg. 2003;23(4):488–93.
  19. Murthy SC, Blackstone EH, Gildea TR, et al. Impact of anastomotic airway complications after lung transplantation. Ann Thorac Surg. 2007;84(2):401–9.
  20. Van De Wauwer C, Van Raemdonck D, Verleden GM, et al. Risk factors for airway complications within the first year after lung transplantation. Eur J Cardiothorac Surg. 2007;31(4):703–1.
  21. Takao M, Katayama Y, Onoda K, et al. Significance of bronchial mucosal blood flow for the monitoring of acute rejection in lung transplantation. J Heart Lung Transplant. 1991;10:956–67.
  22. Schmid RA, Boehler A, Speich R, et al. Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity? Eur Respir J. 1997;10(12):2872–5.
  23. Christie JD, Edwards LB, Kucheryavaya AY, et al; International Society of Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant. 2012 ;31(10):1073–86.
  24. Oto T, Okada Y, Bando T, et al; Japanese Society of Lung and Heart–Lung Transplantation. Registry of the Japanese society of lung and heart-lung transplantation: the official Japanese lung transplantation report 2012. Gen Thorac Cardiovasc Surg. 2013;61:208–11.
  25. Kreisel D, Krupnick AS, Puri V, et al. Short- and long-term outcomes of 1000 adult lung transplant recipients at a single center. J Thorac Cardiovasc Surg. 2011;141:215–22.
  26. Meachery G, De Soyza A, Nicholson A, et al. Outcomes of lung transplantation for cystic fibrosis in a large UK cohort. Thorax. 2008;63:725–31.
  27. Hofer M, Benden C, Inci I, et al. True survival benefit of lung transplantation for cystic fibrosis patients: the Zurich experience. J Heart Lung Transplant. 2009;28:334–9.
  28. Aurora P, Whitehead B, Wade A, et al. Lung transplantation and life extension in children with cystic fibrosis. Lancet. 1999;354:1591–3.
  29. Burton CM, Milman N, Carlsen J, et al. Copenhagen National Lung Transplant Group. The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart-lung transplantation. J Heart Lung Transplant. 2005;24:1834–43.
  30. de Perrot M, Chaparro C, McRae K, et al. Twenty-year experience of lung transplantation at a single center: Influence of recipient diagnosis on long-term survival. J Thorac Cardiovasc Surg. 2004;127:1493–501.
  31. Aaron SD, Ferris W, Henry DA, et al. Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia. Am J Respir Crit Care Med. 2000;161:1206–12.
  32. Inci I, Stanimirov O, Benden C, et al. Lung transplantation for cystic fibrosis: a single center experience of 100 consecutive cases. Eur J Cardiothorac Surg. 2012:41:435–40.
  33. Egan TM, Detterbeck FC, Mill MR, et al. Long-term results of lung transplantation for cystic fibrosis. Eur J Cardiothorac Surg. 2002;22:602–9.
  34. Chaparro C, Maurer J, Gutierrez C, et al. Infection with Burkholderia cepaciain cystic fibrosis: outcome following lung transplantation. Am J Respir Crit Care Med. 2001;163:43–8.
  35. De Soyza A, McDowell A, Archer L, et al. Burkholderia cepacia complex genomovars and pulmonary transplantation outcomes in patients with cystic fibrosis. Lancet. 2001;358:1780–1.
  36. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.
  37. Cassivi SD, Meyers BF, Battafarano RJ, et al. Thirteen-year experience in lung transplantation foremphysema. Ann Thorac Surg. 2002;74:1663–9.
  38. Aigner C, Wisser W, Taghavi S, et al. Institutional experience with extracorporeal membrane oxygenation in lung transplantation. Eur J Cardiothorac Surg. 2007;31(3):468–73.
  39. Hoopes CW, Kukreja J, Golden J, et al. Extracorporeal membrane oxygenation as a bridge to pulmonary transplantation. J Thorac Cardiovasc Surg. 2013;145:862–8.
  40. Barr ML, Schenkel FA, Cohen RG, et al. Recipient and donor outcomes in living related and unrelated lobar transplantation. Transplant Proc. 1998;30:2261–3.
  41. Aigner C, Jaksch P, Taghavi S, et al. Donor total lung capacity predicts recipient total lung capacity after size-reduced lung transplantation. J Heart Lung Transplant. 2005;24:2098–102.
  42. Aigner C, Winkler G, Jaksch P, et al. Size-reduced lung transplantation: an advanced operative strategy to alleviate donor organ shortage. Transplant Proc. 2004;36:2801–5.
  43. Shigemura N, Bermudez C, Hattler BG, et al. Impact of graft volume reduction for oversized grafts after lung transplantation on outcome in recipients with end-stage restrictive pulmonary diseases. J Heart Lung Transplant. 2009;28:130–4.
  44. Artemiou O, Wieselthaler G, Zuckermann A, et al. Downsizing of the donor lung: peripheral segmental resections and lobar transplantation. Transplant Proc. 1997;29:2899–900.
  45. Aigner C, Mazhar S, Jaksch P, et al. Lobar transplantation, split lung transplantation and peripheral segmental resection – reliable procedures for downsizing donor lungs. Eur J Cardiothorac Surg. 2004;25:179–83.
  46. Santos F, Lama R, Alvarez A, et al. Pulmonary tailoring and lobar transplantation to overcome size disparities in lung transplantation. Transplant Proc. 2005;37:1526–9.
  47. Inci I, Irani S, Kestenholz P, et al. Donor predicted post-operative forced expiratory volume in one second predicts recipients’ best forced expiratory volume in one second following size-reduced lung transplantation. Eur J Cardiothorac Surg. 2011;39:115–9.
  48. Benden C, Inci I, Weder W, Boehler A. Size-reduced lung transplantation in children – an option worth to consider! Pediatr Transplant. 2010;14(4):529–33.
  49. Inci I, Schuurmans MM, Kestenholz P, et al. Long-term outcomes of bilateral lobar lung transplantation. Eur J Cardiothorac Surg. 2012;43:1220–5.
  50. Cypel M, Sato M, Yildirim E, et al. Initial experience with lung donation after cardiocirculatory death in Canada. J Heart Lung Transplant. 2009;28:753–8.
  51. Levvey BJ, Harkess M, Hopkins P, et al. Excellent Clinical Outcomes from a National Donation-After-Determination-of-Cardiac-Death Lung Transplant Collaborative. Am J Transplant. 2012;12:2406–13.
  52. Snell GI, Levvey BJ, Oto T, et al. Early lung transplantation success utilizing controlled donation after cardiac death donors. Am J Transplant. 2008;8:1282–9.
  53. De Vleeschauwer S, Van Raemdonck D, Vanaudenaerde B, et al. Early outcome after lung transplantation from non-heart-beating donors is comparable to heart-beating donors. J Heart Lung Transplant. 2009;28:380–7.
  54. Steen S, Söberg T, Pierre L, et al. Transplantation of lungs from a non-hear-beating donor. Lancet. 2001;357:825–9.
  55. Krueger T, Berutto C, Aubert JD. Challenges in lung transplantation. Review article. Swiss Med Wkly. 2011;141:w13292.
  56. Wierup P, Haraldsson A, Nilsson F, et al. Ex vivo evaluation of nonacceptable donor lungs. Ann Thorac Surg. 2006;81:460–6.
  57. Cypel M, Yeung JC, Machuca T, et al. Experience with the first 50 ex vivo lung perfusions in clinical transplantation. J Thorac Cardiovasc Surg. 2012;144:1200–6.
  58. Cypel M, Yeung JC, Liu M, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med. 2011;14;364:1431–40.
  59. Aigner C, Slama A, Hötzenecker K, et al. Clinical ex vivo lung perfusion – pushing the limits. Am J Transplant. 2012;12:1839–47.
  60. Inci I, Arni S, Acevedo C, et al. Surfactant alterations following donation after cardiac death donor lungs. Transpl Int. 2011;24(1):78–84.
  61. Inci I, Ampollini L, Arni S, et al. Ex vivo reconditioning of marginal donor lungs injured by acid aspiration. J Heart Lung Transplant. 2008;27(11):1229–36.
  62. Inci I, Arni S, Inci D, et al. Impact of topical cooling solution and prediction of pulmonary graft viability from non-heart-beating donors. J Heart Lung Transplant. 2008;27(9):1016–22.
  63. Inci I, Zhai W, Arni S, et al. Fibrinolytic treatment improves the quality of lungs retrieved from non-heart-beating donors. J Heart Lung Transplant. 2007;26:1054–60.
  64. Ott HC, Clippinger B, Conrad C, et al. Regeneration and orthotopic transplantation of a bioartificial lung. Nat Med. 2010;16(8):927–33.

Most read articles by the same author(s)