TY  - CHAP
M1  - Book, Section
TI  - Lung Transplantation
A1  - Hachem, Ramsey R.
A2  - Grippi, Michael A.
A2  - Antin-Ozerkis, Danielle E.
A2  - Dela Cruz, Charles S.
A2  - Kotloff, Robert M.
A2  - Kotton, Camille Nelson
A2  - Pack, Allan I.
PY  - 2023
T2  - Fishman’s Pulmonary Diseases and Disorders, 6e
AB  - Lung  transplantation  is  the  ultimate  treatment  for  patients  with  advanced  and  end-stage  lung  diseases.  The  number  of  lung  transplants  performed  annually  has  grown  consistently  over  the  past  30  years  worldwide.1  Indeed,  more  than  4500  lung  transplants  have  been  reported  annually  to  the  International  Thoracic  Organ  Transplant  Registry  of  the  International  Society  for  Heart  and  Lung  Transplantation  (ISHLT).1  Although  donor  organ  availability  is  the  primary  barrier  to  increasing  the  volume  of  procedures  performed,  advances  in  donor  selection,  management,  and  the  use  of  donation  after  circulatory  death  (DCD)  donors  and  ex  vivo  lung  perfusion  (EVLP)  have  expanded  the  donor  pool  and  allowed  growth  in  transplant  volumes  worldwide.2–7  Similarly,  growing  experience  with  lung  transplantation  has  resulted  in  expansion  in  candidate  selection.  Today,  lung  transplant  recipients  are  generally  older,  have  more  severe  lung  disease,  have  more  comorbidities,  and  are  more  likely  to  be  hospitalized  or  require  life  support  before  transplantation  than  10  years  ago.2  Nonetheless,  long-term  survival  after  transplantation  continues  to  improve  compared  with  previous  eras  although  the  magnitude  of  this  improvement  is  small  on  a  year-to-year  basis.1,2  Indeed,  long-term  survival  after  lung  transplantation  remains  significantly  worse  than  after  other  solid  organ  transplants  including  kidney,  liver,  and  heart  transplantation.2,8–10  Chronic  lung  allograft  dysfunction  (CLAD)  has  emerged  as  the  leading  obstacle  to  better  long-term  survival  and  the  most  common  cause  of  death  beyond  the  first  year  after  transplantation.1  The  incidence  of  CLAD  approaches  30%  3  years  after  transplantation,  and  the  clinical  course  is  characterized  by  a  progressive  decline  in  lung  function  culminating  in  severe  clinical  and  physiologic  impairment,  respiratory  failure,  and  death.11–13  Other  important  complications  after  lung  transplantation  include  infections,  cardiovascular  disease,  chronic  kidney  disease  (CKD),  and  malignancy.1  Combined  with  episodes  of  rejection  and  the  development  of  CLAD,  these  comorbidities  adversely  impact  both  quality  of  life  and  survival  after  lung  transplantation.  Better  strategies  and  immunosuppressive  regimens  to  prevent  the  development  of  CLAD  and  minimize  the  development  of  other  complications  are  needed  to  improve  long-term  outcomes  after  lung  transplantation.  These  have  been  the  focus  of  basic,  translational,  and  clinical  studies,  and  ongoing  research  is  critical  to  this  mission.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/23
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1195012505
ER  -