title: Heart and lung transplantation.
abstract: OBJECTIVE
  Every year, thousands of heart and lung transplants are performed worldwide. As experience and clinical acumen advance, both fields are continually evolving. This review elucidates and describes many of the recent changes in practice and future directions of heart and lung transplantation. Preoperative, intraoperative and postoperative developments are presented with supporting evidence in these continually evolving fields.
  
  
  RESULTS
  The field of heart transplantation is continually adapting to the growing use of mechanical circulatory support devices as bridge to transplant and for postoperative support. Recent modifications in surgical technique have contributed to improved outcomes.Lung transplantation advancements include the increasing use of extracorporeal membrane oxygenation during the perioperative period. Lobar transplantation and ex-vivo lung perfusion techniques may aid in providing successful lung grafts to those with potentially long wait list times.Rates of rejection continue to decline in both fields as immunosuppression regimens are improved and modified.
  
  
  CONCLUSIONS
  This review investigates and summarizes the recent changes and advancements in heart and lung transplantation. Mechanical circulatory support and extracorporeal membrane oxygenation are increasingly used in the perioperative setting, and continuing research will evaluate their safety profiles. Optimizing and tailoring immunosuppression regimens for transplant recipients continue to be the subject of ongoing investigation.
authors.affiliation: Cardiothoracic Intensive Care Unit, Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Brigid
authors.initials: B
authors.lastname: Flynn
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hastie
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sladen
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006084:Graft Rejection; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007165:Immunosuppression Therapy; D016040:Lung Transplantation