Skip to Main Content

++

Lung transplantation has become a viable therapy for end-stage lung disease due to pulmonary parenchymal and vascular disease. Early results were suboptimal due to airway complications, the reimplantation response, and lack of effective immunosuppression. Improvements in surgical technique, perioperative care, immunosuppression, and recipient selection have led to better short- and long-term outcomes.

++

The modern era of lung transplantation began when Cooper’s group at the University of Toronto in 1983 performed the first single-lung transplant resulting in long-term survival. Single-lung transplantation has become the most common procedure for emphysema and pulmonary fibrosis. Bilateral lung transplantation is currently performed for patients with cystic fibrosis and pulmonary hypertension. The number of lung transplant procedures reported to the International Society of Heart and Lung Transplantation (ISHLT) Transplant Registry during the past 7 years has quadrupled. In 2001, 1134 lung transplants were performed in North America and 1560 were done worldwide (ISHLT Transplant Registry Quarterly Reports, 2002; http://www.ishlt.org). This increased activity correlates with modestly improved survival rates at 3 months and 1, 3, and 5 years posttransplantation of 86.5%, 76.4%, 57.2% and 42.6%, respectively (http://www.ustransplant.org; Scientific Registry of Transplant Recipients; OPTN/SRTR Data as of August 1, 2001). Although the 5-year survival rate for lung transplantation lags behind that of other solid organ transplants, this therapy has quickly become a major treatment option for patients with terminal lung conditions.

++

The decision to refer a patient for lung transplantation should be made expeditiously, particularly in conditions associated with poor wait-list survival, such as cystic fibrosis and idiopathic pulmonary fibrosis, in which early evaluation and rapid placement on the transplant waiting list are critical. Patients being considered for lung transplantation are counseled that, in effect, they are exchanging one disease for another. They are “trading” their lung disease for a chronic immunosuppressed state. Too much immunosuppression can lead to infections and not enough predisposes the patient to rejection. Each of the immunosuppressive agents has a unique side effect profile. It is not always possible to predict whether the patient will have a longer life with or without a transplant. Although surgical techniques and immunosuppressive regimens have generally improved since the 1980s, there remains substantial morbidity with lung transplantation. Strict compliance to immunosuppressive drugs and early medical intervention at the onset of symptoms of infection or rejection are of paramount importance in achieving long-term survival. What is clear is that successful lung transplantation allows patients to return to work, enjoy an active life, and be free from supplemental oxygen and dyspnea.

++

The leading indications for lung transplantation are outlined in Figure 17–1 and include emphysema (chronic obstructive pulmonary disease, COPD), cystic fibrosis, idiopathic pulmonary fibrosis, α1-antitrypsin deficiency, primary pulmonary hypertension, retransplant/graft failure, and congenital heart disease. These indications vary for pediatric and adult lung transplant recipients. The type of transplant (ie, single-, double-, or heart–lung) that is appropriate for a given patient depends on several factors including the type of lung disease ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.