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The outcomes of heart-lung transplant (HLT) are worse than those of heart transplant (HT) and lung transplant alone; this and the availability of mechanical assistance have meant that the indications for HLT have been changing. This study aims to analyze the evolution of indications for HLT in a country of 47 million inhabitants.We performed a retrospective observational study of all HLTs performed in Spain (performed in 2 centers) from 1990 to 2020. The total number of patients included was 1751 (HT 1673 and HLT 78). After clinical adjustment, overall survival was compared between the 2 groups. Seven etiological subgroups were considered within the HLT group: (1) cardiomyopathy with pulmonary hypertension (CM + PH);, (2) Eisenmenger syndrome, (3) congenital heart disease without Eisenmenger syndrome, (4) idiopathic pulmonary arterial hypertension (IPAH), (5) cystic fibrosis, (6) chronic obstructive pulmonary disease (COPD) and/or emphysema), and (7) diffuse interstitial lung disease.There were a large number of differences between patients with HLT vs HT. HLT had a 2.69-fold increased probability of death in the first year compared with HT. The indications for HLT have changed over the years. In the recent period the indications are mainly congenital heart disease and Eisenmenger syndrome, with some cases of CM + PH. Other indications for HLT have virtually disappeared, mainly lung diseases (IPAH, COPD, cystic fibrosis). Median survival was low in CM + PH (18 days), diffuse interstitial lung disease (29 days), and ischemic heart disease (114 days); intermediate in Eisenmenger syndrome (600 days); and longer in IPAH, COPD and/or emphysema, and cystic fibrosis.HLT is a procedure with high mortality. This and mechanical assists mean that the indications have changed over the years. Etiological analysis is of utmost interest to take advantage of organs and improve survival.

Fundamento y objetivo Describir la incidencia de complicaciones perioperatorias de los pacientes trasplantados de pulmon por enfisema pulmonar y estudiar los factores de riesgo asociados a la morbimortalidad en el postoperatorio inmediato. Pacientes y metodo Estudio retrospectivo que incluye a 69 pacientes trasplantados de pulmon por enfisema pulmonar durante los anos 1994-2002. Se realizo un analisis univariante para identificar las variables asociadas con la incidencia de la mortalidad en la Unidad de Reanimacion o con el aumento de complicaciones postoperatorias. Las variables que presentaron significacion estadistica se sometieron a analisis multivariante mediante el modelo de regresion logistica. Resultados Se incluyo a 65 pacientes. Diecisiete recibieron un trasplante unipulmonar (TUP) y 48 un transplante bilateral secuencial (TBP). Las complicaciones intraoperatorias fueron mas habituales en el grupo del trasplante bipulmonar (35,3% en el TBP frente a 72,9% en el TUP, p Conclusiones Los pacientes con TUP tienen menor numero de complicaciones en el perioperatorio, lo que condiciona una mayor supervivencia durante la estancia en reanimacion. La ventilacion mecanica durante mas de 48 h y la hemorragia posquirurgica fueron las variables que mejor predijeron la mortalidad en el postoperatorio inmediato.