Lung transplantation - overview

15 Oct 2022 11:40 12:10
Tan Han Loong Speaker

Since the first human lung transplantation in 1963, it has continued to grow as a field, particularly after the advent of ciclosporin as well as refinement of surgical technique and lung preservation. Lung transplantation should be considered for adults with chronic, end-stage lung disease who have high mortality within 2 years without transplantation and high likelihood of 5-year post transplant survival. The timing of referral and listing of candidates continues to pose challenges. The appropriate selection of lung transplant recipients is an important determinant of outcomes. An unsuccessful lung transplant affects not only the individual who was transplanted, but also a potential alternative recipient who did not have the opportunity to be transplanted. The indications for lung transplantation can be broadly separated into diffuse parenchymal lung disease, obstructive lung disease, pulmonary vascular disease and suppurative lung disease. Single lung, bilateral lung or combined heart-lung transplantation can be performed depending on the indication for transplantation, recipient factors and donor availability. Bilateral lung transplantation is normally performed as sequential single-lung transplants via the traditional clamshell incision. Donor shortages and chronic lung allograft dysfunction continue to prevent lung transplantation from reaching its full potential. Chronic lung allograft dysfunction is the major contributor to long-term mortality and morbidity while graft failure and infection are the leading cause of death during the first year post transplantation. Careful selection of candidate, retrieval and preservation of donor lung in good condition, well-performed surgery and concerted effort of multidisciplinary team are keys to success in lung transplantation.