THE PAST, PRESENT, AND FUTURE OF LUNG TRANSPLANTATION

BACKGROUND: The history of lung transplantation from the first human t ransplant performed in 1963 to the present is reviewed with particular focus on the added challenges because of the contaminated bronchus, e xposure of the graft to airborne organisms, the poor blood supply to t he bronchus, and the problem of reperfusion pulmonary edema. METHODS: The technical aspects of single and double sequential lung transplanta tion are reviewed, as are the current indications for single, double s equential, and heart/lung transplantation. Criteria for lung transplan t recipients, in addition to their primary disease are noted, as are a bsolute and relative contraindications. The standard criteria for dono r selection are also reviewed. RESULTS: The results of single, double sequential, and heart-lung transplantation over the past 10 years as r eported by the International Society for Heart and Lung Transplantatio n Database are reviewed. In addition, the statistics of the lung and h eart-lung transplantation program at the University of Colorado Health Sciences Center are reviewed, including the current immunosuppressive regimens and early and late monitoring for infection and rejection. T his experience includes 3 early deaths in the first 53 patients for an operative mortality of 5.6%, with a 1-year actuarial survival of 90%. CONCLUSIONS: During the past decade remarkable improvement in the res ult of single and double sequential lung transplantation have occurred . As 1-year, actuarial survival is now approaching 90% at some institu tions. Living related lobar transplantation, new antirejection agents, chimerism, and xenograft transplantation are areas for continuing and future investigation. The shortage in donor organ supply continues to be a very significant factor in limiting human lung transplantation. (C) 1997 by Excerpta Medica, Inc.