Lung Transplantation

Part of the Springer Surgery Atlas Series book series (SPRISURGERY)


Lung transplantation (LTx) is a successful treatment modality for carefully selected patients suffering from different forms of end-stage lung disease. The aim of this replacement therapy is not only to prolong survival but also to improve quality of life in patients at home or hospital bound that are often oxygen dependent with limited exercise capacity and activities of daily life. This ultimate therapy, just as transplantation for failure of any other solid organ, is limited by the shortage of suitable donors and acceptable grafts. In addition, LTx is hampered by early- and late-stage complications related to primary graft dysfunction, acute and chronic rejection (the so-called chronic lung allograft dysfunction), opportunistic infections, malignancies, and other side effects of lifelong immunosuppressive therapy. Further research to better understand the mechanisms behind these problems and to find new solutions to deal with limitations and obstacles of LTx is needed [1].


Lung transplantation Surgical techniques 



Dirk Van Raemdonck was a senior clinical investigator supported by the Fund for Research-Flanders (G.3C04.99). We acknowledge the large contribution of all members of the Leuven Lung Transplant Group ( to the success of our program.

Disclosures: Dirk Van Raemdonck was a consultant for Transmedics, Andover, MA, currently acting as principal co-investigator of the Expand Trial. He received research support from XVIVO Perfusion (XVIVO), Göteborg, Sweden, in the past.

Supplementary material

Video 3.1

Patient position on the operating table ready for bilateral thoracotomy (MP4 1623 kb)

Video 3.2

Preparing the donor lung (MP4 8492 kb)

Video 3.3

Bronchial anastomosis (MP4 14713 kb)

Video 3.4

Pulmonary arterial anastomosis (MP4 13803 kb)

Video 3.5

Left atrial anastomosis (MP4 14988 kb)

Video 3.6

Reperfusion and ventilation of the donor lung (MP4 6882 kb)


  1. 1.
    Vigneswaran WT, Garrity ER, editors. Lung transplantation. New York: Informa Health Care; 2010.Google Scholar
  2. 2.
    Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-second official adult lung and heart-lung transplant report-2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34:1264–77.CrossRefGoogle Scholar
  3. 3.
    Van Raemdonck D, Neyrinck A, Verleden GM, et al. Donor selection and management. Proc Am Thorac Soc. 2009;6:28–38.CrossRefGoogle Scholar
  4. 4.
    Kaiser LR, Pasque MK, Trulock EP, et al. Bilateral sequential lung transplantation: the procedure of choice for double-lung replacement. Ann Thorac Surg. 1991;52:438–46.CrossRefGoogle Scholar
  5. 5.
    Bisson A, Bonnette P. A new technique for double lung transplantation. “Bilateral single lung” transplantation. J Thorac Cardiovasc Surg. 1992;103:40–6.CrossRefGoogle Scholar
  6. 6.
    Meyers BF, Sundaresan RS, Guthrie T, et al. Bilateral sequential lung transplantation without sternal division eliminates posttransplantation sternal complications. J Thorac Cardiovasc Surg. 1999;117:358–64.CrossRefGoogle Scholar
  7. 7.
    Koster TD, Ramjankham FZ, van de Graaf EA, et al. Crossed wiring closure technique for bilateral transverse thoracosternotomy is associated with less sternal dehiscence after bilateral sequential lung transplantation. J Thorac Cardiovasc Surg. 2013;146:901–5.CrossRefGoogle Scholar
  8. 8.
    Venuta F, Rendina EA, De Giacomo T, et al. Bilateral sequential lung transplantation without sternal division. Eur J Cardiothorac Surg. 2003;23:894–7.CrossRefGoogle Scholar
  9. 9.
    Van Berkel V, Guthrie TJ, Puri V, et al. Impact of anastomotic techniques on airway complications after lung transplant. Ann Thorac Surg. 2011;92:316–21.CrossRefGoogle Scholar
  10. 10.
    Aigner C, Jaksch P, Seebacher G, et al. Single running suture—the new standard technique for bronchial anastomosis in lung transplantation. Eur J Cardiothorac Surg. 2003;23:488–93.CrossRefGoogle Scholar
  11. 11.
    Casula RP, Stoica SC, Wallwork J, et al. Pulmonary vein augmentation for single lung transplantation. Ann Thorac Surg. 2001;71:1373–4.CrossRefGoogle Scholar
  12. 12.
    Gamez P, Alvarez R, Hernández H, et al. Lung transplantation: how to do the venous anastomosis when the pulmonary graft has no auricular cuff. J Heart Lung Transplant. 2005;24:1123–5.CrossRefGoogle Scholar
  13. 13.
    Oto T, Rabinov M, Negri J, et al. Techniques of reconstruction for inadequate donor left atrial cuff in lung transplantation. Ann Thorac Surg. 2006;81:1199–204.CrossRefGoogle Scholar
  14. 14.
    Puri V, Patterson GA. Adult lung transplantation: technical considerations. Semin Thorac Cardiovasc Surg. 2008;20:152–64.CrossRefGoogle Scholar
  15. 15.
    Yarbrough WM, Bates MJ, Deuse T, et al. Alternative technique for salvage of donor lungs with insufficient atrial cuffs. Ann Thorac Surg. 2009;88:1374–6.CrossRefGoogle Scholar
  16. 16.
    de Perrot M, Keshavjee S. Everting mattress running suture: an improved technique of atrial anastomosis in human lung transplantation. Ann Thorac Surg. 2002;73:1663–4.CrossRefGoogle Scholar

Suggested Reading

  1. Boaquevisque CH, Yildirim E, Waddell TK, et al. Surgical techniques: lung transplant and lung volume reduction. Proc Am Thorac Soc. 2009;6:66–78.CrossRefGoogle Scholar
  2. Fernandez FG, Patterson GA. Lung transplantation. In: Shields TW, Locıcero JIII, Reed CE, Feins RH, editors. General thoracic surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 1241–67.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Thoracic Surgery DepartmentIstanbul University, Istanbul School of MedicineIstanbulTurkey
  2. 2.Department of Thoracic SurgeryUniversity Hospitals LeuvenLeuvenBelgium

Personalised recommendations