Lung and heart-lung transplantation: overview of results

During the last decade, activity in lung transplantation increased rapidly to a plateau of approximately 900 transplants per year in the United States, and it is unlikely to increase further unless the supply of usable donor organs can be expanded. However, the demand for lung transplantation has continued to rise, and the median waiting time for lung transplantation in the United States is approaching 2 years. The main indications for lung transplantation have been chronic obstructive pulmonary disease, alpha1-antitrypsin deficiency emphysema, cystic fibrosis, idiopathic pulmonary fibrosis, primary pulmonary hypertension, and Eisenmenger's syndrome. Overall, survival after lung transplantation has been good, with 1-, 3-, and 5-year survival rates of 75, 58, and 44%, respectively, and the results have been improving. Chronic rejection and infection have been the main causes of medium-term mortality, and the high prevalence of chronic rejection remains a barrier to better outcomes. Quality of life has been enhanced by lung transplantation, but the posttransplantation immunosuppressive regimen has been associated with considerable morbidity.