title: [Lung transplantation].
abstract: Lung transplantation (LT) has evolved to become an important alternative in the management of patients with end-stage pulmonary disease and chronic respiratory failure. The beginnings of this technique can be traced back to the experiments of Carrel and Guthrie over a hundred years ago. However, it was not until 1963 when the first clinical experience was performed by Hardy. Clinical success did not arrive until the 1980's thanks to the works of the Toronto Lung Transplant Group. Well established criteria have been described in order to consider a patient as a potential candidate to receive a lung. Several diseases are capable of causing terminal lung damage and in general they can be classified according to their origin as obstructive (COPD, emphysema), restrictive (fibrosis), chronic infectious (cystic fibrosis, bronquiectasis), and vascular (primary pulmonary hypertension). The most frequent diagnosis is COPD. Clinically relevant modes of LT include the implant of one lung (single LT), or both lungs (bilateral sequential LT). Transplantation of the cardiopulmonary block is reserved for special situations and lobar transplantation is still considered experimental. Donor condition is essential to the success of LT. The potential donor patient frequently suffers deterioration in lung function due to edema formation or infection and both complications restrict lung's using for transplantation. Lung preservation is also limited to a short period of time which rarely exceeds 6 hours in spite of specially-designed preservative solutions such as the low potassium dextran. Outcome after LT shows current one-year survival between 65-70% with reduction to 40-45% after five years. Mortality within the first year is usually related to primary graft failure and infection. Long-term survival depends on controlling infectious problems due to immunosuppression as well as the development of bronchilitis obliterans as a manifestation of chronic rejection. LT is a therapeutic modality reserved for selected patients with chronic respiratory failure due to end-stage lung disease.
authors.affiliation: Departamento de Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF. psantdod@quetzal.innsz.mx
authors.forename: Patricio
authors.initials: P
authors.lastname: Santillán-Doherty
authors.forename: Rogelio
authors.initials: R
authors.lastname: Jasso-Victoria
authors.forename: Raúl
authors.initials: R
authors.lastname: Olmos-Zúñiga
authors.forename: Avelina
authors.initials: A
authors.lastname: Sotres-Vega
authors.forename: Luis Marcelo
authors.initials: LM
authors.lastname: Argote-Greene
authors.forename: Tomás
authors.initials: T
authors.lastname: Escalante-Tattersfield
authors.forename: Jaime
authors.initials: J
authors.lastname: Villalba-Caloca
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007239:Infections / Q000401:mortality; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods / Q000639:trends; D008800:Mexico; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality; D016019:Survival Analysis; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome