Lung and Heart-Lung Transplantation: A Review of Progress and Current Status based on the Registry of the International Society for Heart and Lung Transplantation

Abstract

The past decade has witnessed the rise of lung transplantation (LTx) as a viable clinical entity, and has seen substantial revisions in the concepts underlying the techniques and indications for LTx and heart-lung transplantation (HLTx). From rather inauspicious beginnings in the late 1960s and 1970s, LTx has emerged as a modality useful for treating both end-stage primary lung disease in a variety of settings[1]’[17] and the pulmonary sequelae of congenital heart disease[4],[7],[15],[18]’[21]. Over 500 single lung, 300 double lung, and 100 heart-lung transplants were carried out in 1994 (Figures 1-3). Single (SLTx) and double (or, more correctly, bilateral single) (DLTx) lung transplantation have resulted in substantial reversibility of right heart dysfunction secondary to pulmonary vascular disease in both primary and secondary pulmonary hypertension, allowing preservation of the patient’s own heart where formerly HLTx was considered a necessity[19],[22]. This has resulted in a significant reduction in the number of heart-lung transplants yearly (Figure 3). In addition, the routine use of DLTx in septic conditions, such as cystic fibrosis and bronchiectasis, has demonstrated that transplantation and immunosuppression can be carried out in a unique setting of infection where significant residual bacterial colonization still exists in other body reservoirs[2],[23],[24].