Lung transplantation

2010 ◽  
pp. 3476-3485
Author(s):  
P. Hopkins ◽  
K. McNeil
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cystic Fibrosis ◽  
Lung Transplantation ◽  
Therapeutic Option ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Obstructive Pulmonary Disease ◽  
Substance Addiction ◽  
Recipient Selection

Lung transplantation offers the only therapeutic option for many patients with a variety of endstage pulmonary and cardiopulmonary diseases, but donors are scarce and the major challenge facing lung transplantation (as with all solid organ transplants) is the critical shortage of donor organs. Recipient selection—emphysema/chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary vascular disease are the main disease groups referred for lung transplantation. Most patients are listed for transplantation when their survival is estimated to be less than 2 years without a transplant. Exclusion criteria include malignancy (excluding localized skin malignancies) within the last 2 years, inability to cooperate or comply with medical therapy/instruction, recent substance addiction, active or noncurable extrapulmonary infection, significant chest wall/spinal deformity, and significant extrathoracic organ dysfunction....

Lung transplantation

2020 ◽  
pp. 4292-4304
Author(s):  
P. Hopkins ◽  
A.J. Fisher
Keyword(s):  
Lung Transplantation ◽  
Life Support ◽  
Therapeutic Option ◽  
Systemic Infection ◽  
Neurological Injury ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Obstructive Pulmonary Disease ◽  
Almost All

Lung transplantation offers the only therapeutic option for many patients with end-stage pulmonary and cardiopulmonary diseases, but donors are scarce and the major challenge facing lung transplantation (as with all solid organ transplants) is the shortage of donor organs. Emphysema/chronic obstructive pulmonary disease, cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary vascular disease are the main disease groups referred for lung transplantation. Most suitable patients are listed for transplantation when their 2-year survival is estimated to be less than 50% without transplantation. Almost all organs come from cadaveric donors who have sustained brainstem death, but an increasing proportion come after withdrawal of life support leads to cardiac death in those who have sustained irreversible cardiac or neurological injury. Ideal donors have satisfactory lung function and are free of systemic infection and disease. Donor/recipient matching is on the basis of ABO blood group, and size.

Chronic Obstructive Pulmonary Disease and Lung Transplantation

2020 ◽  
Vol 41 (06) ◽  
pp. 862-873
Author(s):  
Mark Greer ◽  
Tobias Welte
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Transplantation ◽  
Pulmonary Disease ◽  
Solid Organ Transplantation ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Obstructive Pulmonary Disease ◽  
Maximal Medical Therapy ◽  
End Stage

AbstractLung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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