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.
KeywordsLung transplantation History of transplantation Referral criteria Surgical techniques Transplant immunosuppression Transplant complications Acute rejection Infection prophylaxis Medication interactions and side effects Chronic lung allograft dysfunction
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