Current status of lung transplantation

Abstract

Two decades have passed since the first successful clinical lung transplant was performed in 1983, and, in the interim, lung transplantation has become the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has been made in the field through refinement of technique and improved understanding of transplant immunology and microbiology.Unfortunately, donor shortages continue to limit the more widespread application of lung transplantation. In order to address this issue, marginal donors, living lobar and split lung donor techniques, and nonheartbeating donors have been used clinically to increase the number of donor lungs available.Chronic rejection of the lung allograft is currently the major hurdle limiting longterm survival. To date, prevention of known risk factors and treatment strategies have not lessened the devastating toll this process has on lung transplant survival. Better understanding of the cause of chronic rejection is needed in order to develop novel strategies for its treatment. Promotion of immune tolerance is a promising area that could potentially eliminate chronic rejection.The present article discusses recent advances in lung transplantation. It also details the major issues facing the field today. Only through continued clinical and experimental investigation will lung transplantation eventually reach its full potential. Eur Respir J 2003; 22: Suppl. 47, 57s-64s.

Dependency of the Trans Vivo Delayed Type Hypersensitivity Response on the Action of Regulatory T Cells: Implications for Monitoring Transplant Tolerance

“…Indirect allorecognition is thought to be the main immunological driving force behind chronic rejection (20 -22), and chronic rejection remains the single most important cause of allograft loss in solid organ transplantation (23). Peptide antigens presented by host MHC molecules are the natural way that the immune system recognizes antigen and the response that is measured using the classic DTH assay after subcutaneous injection of soluble antigens such as tuberculin is mediated in the same way.…”

Multiple Variables Affecting Blood Usage in Lung Transplantation

“…17 Anemia and the requirement for blood product transfusions both during and after transplantation remains a critical component in the management of lung transplant recipients, yet very limited data have been published regarding the blood products used in this context. In this study, we analyzed the blood product usage of RBC, FFP and PLT in lung transplantation and determined the relationships between the types of surgical procedure and the patient's diagnosis with the components utilized.…”

Treatment of chronic respiratory failure: lung volume reduction surgeryversusrehabilitation

“…These treatments are increasingly successful, which has resulted in a clear improvement in survival in patients receiving long-term oxygen treatment since the 1980s [15]. Most of these treatment modalities are discussed in the present supplement, with lung transplantation being discussed by LAU and PATTERSON [16]. The present contribution reviews two treatment modalities that are complementary in the treatment of COPD patients: rehabilitation and LVRS.…”