Current trends in candidate selection, contraindications, and indications for lung transplantation

Abstract

Lung transplant has been established as the treatment of choice for patients with various forms of end-stage lung disease, in whom non-transplant therapeutic options have failed. Many advances in the realms of basic science, clinical research, surgical technique, and perioperative management have emerged over the past few decades; these innovations have contributed to substantial improvements in survival and quality of life for transplant recipients. However, the field of lung transplantation faces appreciable challenges, including expanding the lung donor pool and ameliorating posttransplant complications, such as primary graft dysfunction, cellular-and antibodymediated rejection, chronic lung allograft dysfunction, and infection (1). One of the most important questions

Recipient Management before Lung Transplantation

“…Localized skin cancer (non-melanoma) is not considered a contraindication to lung transplantation, and a 2-year disease-free interval may be acceptable for skin cancers other than melanoma [ 51 ]. However, in most cases (hematologic malignancy, sarcoma, or cancers of the bladder, kidney, or breast), a 5-year disease-free interval should be demonstrated [ 52 ]. In particular, the risk of recurrence may be high in patients with bronchial carcinoma even after a 5-year disease-free interval, which warrants further research [ 52 , 53 ].…”

“…However, in most cases (hematologic malignancy, sarcoma, or cancers of the bladder, kidney, or breast), a 5-year disease-free interval should be demonstrated [ 52 ]. In particular, the risk of recurrence may be high in patients with bronchial carcinoma even after a 5-year disease-free interval, which warrants further research [ 52 , 53 ].…”

Is there life on the airway tree? A pilot study of bronchial cell vitality and tissue morphology in the ex vivo lung perfusion (EVLP) era of lung transplantation

“…Lung transplantation (LTx) represents the best therapeutic approach to several end‐stage lung diseases, such as cystic fibrosis, advanced chronic obstructive pulmonary disease, idiopathic interstitial pneumonia and interstitial lung disease, alpha‐1 antitrypsin deficiency‐related emphysema, and idiopathic pulmonary arterial hypertension. 1 , 2 Similar to other solid organ transplants, LTx suffers from a limited donor pool and it is burdened by early phase and long‐term complications, such as ischemic‐reperfusion injury (IRI), primary graft dysfunction (PGD), infection, rejection, and chronic lung allograft dysfunction. 1 , 2 , 3 , 4 In particular, IRI is a harmful condition harboring the potential to induce PGD and increase patient overall morbidity, mortality, and long‐term complications such as chronic lung allograft dysfunction.…”

“… 1 , 2 Similar to other solid organ transplants, LTx suffers from a limited donor pool and it is burdened by early phase and long‐term complications, such as ischemic‐reperfusion injury (IRI), primary graft dysfunction (PGD), infection, rejection, and chronic lung allograft dysfunction. 1 , 2 , 3 , 4 In particular, IRI is a harmful condition harboring the potential to induce PGD and increase patient overall morbidity, mortality, and long‐term complications such as chronic lung allograft dysfunction. 5 IRI is defined as aseptic inflammatory damage of the graft due to mitochondrial injury and reactive oxygen species release.…”

Outcomes of Recipients Aged 65 Years and Older Bridged to Lung Transplant With Extracorporeal Membrane Oxygenation

“…Given the aging lung transplant population, 15–18 we sought to further explore the association of recipient age to ECMO BTT in this study by assessing posttransplant outcomes in patients of greater than or equal to 65 years who received no BTT, MV-only BTT, and ECMO BTT.…”