Lung transplantation from past to future: an overview

Abstract

Lung transplantation is performed on patients with terminal lung diseases and is generally done in two scenarios: when a patient with terminal stage lung disease is predicted to have 50% or less chances of survival in the next 2–3 years and/or advancement of lung disease to such a stage that clear survival advantage of lung transplantation is evident. It was first done in humans in 1963 by Dr James Hardy. Proper timing of transplant is important. It should be neither too late nor too early. Listing of patients for lung transplantation was initially a problem but subsequently with the introduction of lung allocation scores (LAS) by the United Network for Organ Sharing in 2005, the waiting list mortality has decreased significantly. LAS is a concept to prioritize organ allocation based on the expected survival advantage of transplantation. The LAS is aimed to pick up the best-suited candidates for transplant and to decrease waiting list mortality. The decision to do single or double lung transplantation is multifactorial. It depends on transplant indications, recipient factors, and donor availability. As with any other transplant, lung transplantation needs posttransplant immunosuppression. Postlung transplant immunosuppression generally consists of a regimen consisting of calcineurin inhibitors, purine synthesis antagonists, and prednisolone. Immunosuppression and drug toxicity are the main cause of early complications. Complications vary with time postoperatively. Primary graft dysfunction is the major concern in the first month after transplant. Acute rejection infections predominate in the subsequent posttransplant period. Neoplasia and chronic lung allograft dysfunction predominate after the first year. The initial attempts resulted in a poor outcome but is now routinely performed as the results have been much more promising in this era due to advances in surgical techniques and immunosuppression regimens. Lung transplantation no doubt offers better survival but is still unfortunately only 50% at 5 years. There is somewhat unawareness among the clinicians about lung transplantation. Our primary aim of this review is to aware young clinicians about the possible role of lung transplantation in terminal lung diseases. Thus, keeping in mind our primary aim, this review provides an overview of lung transplantation in terms of historical background, candidate selection criteria, concept of LAS, methods of bridging to transplantation, single versus bilateral transplantation, post-lung immunosuppression, outcome, and complications.

Keywords

• bridging
• candidate selection
• complications
• lung allocation scores
• lung transplantation
• pulmonary disease
• single/bilateral
• survival