Introduction

As we began the new millennium, growth in the field of solid organ transplantation had spurred renewed interest of the transplant community in lung transplantation. It has been more than 35 years since the first human lung transplant procedure was performed at the University of Mississippi in a patient with severe emphysema and carcinoma of the left bronchus.[1] The patient died 18 days later of renal failure. Those in the field of lung transplantation have certainly learned from the perils of early experiences. As with other types of organ transplantation, progress during the early years (1963-1980) was slow with dismal results. Major causes of death were related to poor recipient and donor selection, respiratory failure, surgical technique, infection, inadequate immunosuppression and rejection, and disruption of the airway anastomosis.[2,3,4] However, considerable progress was made during the 1980s.

In 1986, the Stanford group performed a successful heart-lung transplantation, which rekindled enthusiasm for the clinical application of lung transplantation.[5] In the same year, the Toronto Lung Transplant Group reported the first successful single-lung transplant, which led to a series of clinical advances in lung transplantation.[6,7] They attributed their success in single-lung transplantation to several factors: the use of cyclosporine (CsA) for initial immunosuppression; avoidance of corticosteroids in the early postoperative period (2-3 weeks); the use of the bronchial omental wrap to protect, vascularize, and nourish the bronchus; and improved patient selection criteria.[7,8,9,10] In 1988 and 1989, the Toronto Lung Transplant Group was also the first to report success with en bloc double-lung transplantation in humans.[11]

The objectives of this chapter are to:

 

  • Describe the current status of lung transplantation

  • List underlying diseases and conditions that may result in the need for lung transplantation

  • Identify patient populations who may benefit from lung transplantation

  • Outline key steps in the evaluation of patients for lung transplantation

  • Summarize current recommendations for immunosuppression

  • List the most common postoperative complications of lung transplantation

  • Discuss recent advances in treatment and management of lung transplant recipients.

 

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