Which patients should receive lung transplants?
Lung transplantation is a therapeutic option for selected patients with end-stage respiratory failure from a variety of pulmonary vascular and parenchymal lung diseases. Early problems due to ischaemic dehiscence of the bronchial anastomosis were avoided with heart-lung transplantation where the coronary bronchial collateral circulation remains intact. With the increase in number of cardiac transplantation, the number of heart-lung blocks available for heart-lung transplantation are declining significantly. Improved techniques now make double lung, bilateral single lung and single lung transplantations suitable alternatives to heart-lung transplantations for many patients, with good anastomotic healing and encouraging results. Patients should only be accepted onto the transplant waiting list if they have deteriorating chronic respiratory failure with a severely impaired quality of life. All patients require a detailed pre-transplant medical and psychosocial assessment. While the absolute contraindications to transplantation include pre-existing malignant disease, active aspergillus or mycobacterial infection, infection with HIV or hepatitis B and noncompliance with treatment, new haemostatic techniques have made it possible to treat many patients who have had previous thoracic surgery. Advances in immunosuppressive agents and post-operative medical care have led to improved survival and quality of life. However, obliterative bronchiolitis remains a serious problem. Demand will always be in excess of available human organs. It is hoped that the development of successful xenografting will enable more patients to benefit from lung transplantation.
Madden
B P
BP
Royal Brompton National Heart & Lung, Hospital, London, UK.
Geddes
D M
DM
D001989:Bronchiolitis Obliterans / Q000209:etiology; D000075202:Contraindications; D015276:Health Care Rationing / Q000592:standards; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D010347:Patient Care Planning / Q000592:standards*; D011182:Postoperative Care / Q000592:standards; D011300:Preoperative Care / Q000592:standards; D011788:Quality of Life; D009927:Tissue and Organ Procurement; D006113:United Kingdom; D014850:Waiting Lists