PULMONARY TRANSPLANTATION

Objective More than 2700 lung transplants have been performed since th e initial clinical success in 1983. The evolution in the techniques of lung transplantation and patient management and the effects on result s are reviewed. Summary Background Data Improvements in donor manageme nt, lung preservation, operative techniques, immunosuppression managem ent, infection prophylaxis and treatment, rejection surveillance, and long-term follow-up have occurred in the decade following the first cl inically successful lung transplant. A wider spectrum of diseases and patients treated with lung transplant have accentuated the shortage of suitable lung donors. The organ shortage has led to the use of margin al donors and a limited experience using living, related donors. Metho ds Changes in techniques and patient selection and management are revi ewed and controversial issues and problems are highlighted. Results On e-year survival of greater than 90% for single-lung transplant recipie nts and greater than 85% for bilateral lung transplant recipients have been achieved. Complications caused by airway complications has been reduced greatly. Obliterative bronchiolitis develops in 20% to 50% of long-term survivors and is the leading cause of morbidity and mortalit y after the first year after transplant. Conclusions Lung transplantat ion has evolved into an effective therapy for a wide variety of causes of endstage lung disease. Wider applicability requires solutions to t he problems of donor shortage and development of obliterative bronchio litis.