Abstract
The outcome of lung transplant recipients has progressively improved over the decades, related to improved candidate selection, the development of lung allocation policies, advances in surgical techniques, and an evolution of post-transplant care. A revision of the International Society for Heart and Lung Transplantation (ISHLT) criteria to guide referral and listing for lung transplantation is presented. Recent developments in post-transplant care are discussed, including the management of specific early and late transplant-related complications, specifically primary graft dysfunction, acute cellular and humoral rejection, infection, and chronic lung allograft dysfunction (CLAD). Effective immunosuppression is required, an awareness of drug interactions, and recognition of potential long-term adverse side effects. In the face of increasingly resistant micro-organisms, an effective anti-microbial strategy is required for optimum management. A revised classification of CLAD is discussed, including the established obstructive phenotype (Bronchiolitis Obliterans Syndrome, BOS) and a more recently described restrictive phenotype (Restrictive Allograft Syndrome, RAS), with its significant impact on long-term survival.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Rutherford RM, Lordan JL, Fisher AJ, Corris PA. Historical overview of lung and heart-lung transplantation. In: Lynch JP, editor. Lung biology in health and disease; 2006. p. 1–16.
Yusen RD, Edwards LB, Kucherayavaya AY, Benden C, Dipchand AI, Goldfarb SB, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-second official adult lung and heart-lung transplantation report--2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34(10):1264–77.
Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014 – an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34:1):1–15.
Judge EP, Foweraker JE, Lordan JL. Infectious disease issues pertinent to cystic fibrosis patients in the pre-lung transplantation period. In: Mooney ML, Hannan MM, Husain S, Kirklin JK, editors. ISHLT monograph 5: diagnosis and management of infectious diseases in cardio-thoracic transplantation and mechanical circulatory support. Addison: International Society of Heart and Lung Transplantation; 2011.
Lobo LJ, Noone PG. Respiratory infections in patients with cystic fibrosis undergoing lung transplantation. Lancet Respir Med. 2014;2(1):73–82.
Yates B, Murphy DM, Fisher AJ, Gould FK, Lordan JL, Dark JH, et al. Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation. BMJ Case Rep. 2009;2009. pii: bcr11.2008.1218. https://doi.org/10.1136/bcr.11.2008.1218.
Lordan JL, Corris PA. Pulmonary arterial hypertension and lung transplantation. Expert Rev Respir Med. 2011;5(3):441–54.
Cypel M, Yeung JC, Liu M, Anraku CF, Karolak W, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med. 2011;364(15):1431–40.
de Perrot M, Granton JT, McRae K, Cypel M, Pierre A, Waddell TK, et al. Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation. J Heart Lung Transplant. 2011;30(9):997–1002.
Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185(7):763–8.
Fischer S, Simon AR, Welte T, Hoeper MM, Tessman R, Meyer A, et al. Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J Thorac Cardiovasc Surg. 2006;131(3):719–23.
Hartert M, Senbaklavacin O, Gohrbandt B, Fischer BM, Buhl R, Vahld CF. Lung transplantation: a treatment option in end-stage lung disease. Dtsch Arztebl Int. 2014;111(7):107–16.
Aigner C. Lobar lung transplantation: more than bits and pieces. Eur J Cardiothorac Surg. 2014;45(2):370–1.
Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D, et al. Report of the ISHLT Working Group on primary lung graft dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2005;24(10):1454–9.
Remund KF, Best M, Egan JJ. Infections relevant to lung transplantation. Proc Am Thorac Soc. 2009;6(1):94–100.
Husain S, Sole A, Alexander BD, Aslam S, Avery R, Benden C, et al. The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: executive summary. J Heart Lung Transplant. 2016;35(3):261–82.
McDonnell M, Lordan J. Review of immunosuppressive treatment in lung transplantation. Turk Thorac J. 2014;15:94–101.
Vanaudenaerde BM, Meyts I, Vos R, Geudens N, De Wever W, Verbeken EK, et al. A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy. Eur Respir J. 2008;32(4):832–43.
Suwara M, Vanaudenaerde BM, Verleden SE, Vos R, Green NJ, Ward C. Mechanistic differences between phenotypes of chronic lung allograft dysfunction after lung transplantation. Transpl Int. 2014;27(8):857–67.
Corris PA, Ryan VA, Small T, Lordan J, Fisher AJ, Meachery G, et al. A randomised controlled trial of azithromycin therapy in bronchiolitis obliterans syndrome (BOS) post lung transplantation. Thorax. 2015;70(5):442–50.
Robertson AG, Ward C, Pearson JP, Smart T, Lordan J, Fisher AJ, et al. Longitudinal changes in gastro-oesophageal reflux from 3 months to 6 months after lung transplantation. Thorax. 2009;64(11):1005–7.
Botha P, Archer L, Anderson RL, Lordan J, Dark JH, Corris PA, et al. Pseudomonas aeruginosa colonization of the allograft after lung transplantation and the risk of bronchiolitis obliterans syndrome. Transplantation. 2008;85(5):771–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Lordan, J.L. (2018). Transplantation. In: Hart, S., Greenstone, M. (eds) Foundations of Respiratory Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-94127-1_20
Download citation
DOI: https://doi.org/10.1007/978-3-319-94127-1_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-94125-7
Online ISBN: 978-3-319-94127-1
eBook Packages: MedicineMedicine (R0)