Lung transplantation may offer an improved quality of life and prolonged survival for patients with end-stage lung disease. However, significant challenges still persist, keeping survival lower than desired for this vulnerable population. There are a number of early and late complications of lung transplantation including primary graft dysfunction, cellular and antibody-mediated rejection, chronic lung allograft dysfunction, early/late infectious complications and post-transplant lymphoproliferative disease.
The lung transplant community including both medical professionals as well as patients and families have worked collaboratively to improve outcomes. Important advances have occurred in a number of different areas and include:
-Patient selection- Improved understanding of lung transplant recipient selection criteria has expanded the number of lung transplants performed. Age greater than 65 years, by itself, has no longer been noted to be an absolute contraindication to lung transplantation. In addition, younger patients have successfully received ABO incompatible lung transplants, shortening their time on the waitlist and improving wait list survival.
- Donor pool- Numerous innovations in donor selection and management have increased the number of donor lungs available for lung transplantation. One major advance has included the greater number of donations after circulatory death (DCD) both in pediatric and adult lung transplantation. A number of studies have successfully shown equal outcomes both with DCD donors as well as donors after brain death declaration. In addition, ex vivo lung perfusion has been developed in an attempt to both evaluate and improve the quality of lungs being considered for potential transplantation. Clinical trials are underway to determine whether ex vivo lung perfusion will result in increased donor quality as well as an increased donor pool.
-Treatment for Chronic Lung Allograft Dysfunction (CLAD)- The greatest risk to survival for lung transplant patients includes the development of chronic lung allograft dysfunction (CLAD). This was formerly known as bronchiolitis obliterans syndrome (BOS) and involves both an obstructive and restrictive phenotype. Past and current studies have attempted to identify the risk factors for the development of CLAD and these likely include; primary graft dysfunction, cellular and antibody-mediated rejection, gastroesophageal reflux disease and infections. Studies have evaluated numerous treatments for some of these risk factors including; bortezomib and eculizimab therapy for antibody mediated rejection, the development of newer calcineurin inhibitors with decreased toxicity and the increased use of extracorporeal photopheresis (ECP) for CLAD.
While this is merely an introduction to the work taking place in lung transplantation to improve outcomes, we hope that Lung Transplant Week will serve to improve your understanding of this critical therapy available to patients with end-stage lung disease. We hope that with continued partnership between clinicians and patients/families, we will see even greater advances in the years to come.
Four Facts About Lung Transplant
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