[Lung transplantation: the current state of knowledge]

Area of Science:

• Cardiovascular and Pulmonary Medicine
• Surgical Innovation
• Transplant Immunology

Context:

• The evolution of lung transplantation began with advancements in immunosuppression and surgical techniques in the early 1980s.
• Heart-lung transplantation was initially prevalent, but single and double lung transplants have become increasingly common for specific end-stage lung diseases.
• Lung transplantation offers a survival benefit for patients with end-stage lung disease, with expected survival less than two years without intervention.

Purpose:

• To review the historical development and current status of lung transplantation.
• To outline the indications for different types of lung transplants (heart-lung, single, double).
• To discuss survival rates, complications, and limitations of lung transplantation.

Summary:

• Lung transplantation has progressed significantly since the 1980s, with key milestones including the development of cyclosporin and en bloc heart-lung transplantation.
• Single lung transplantation is increasingly favored for pulmonary hypertension, fibrosis, and emphysema, while double lung transplantation is indicated for cystic fibrosis and emphysema in younger patients.
• Survival rates are approximately 65% at one year, improving prognosis for end-stage lung disease patients, though challenges like technical difficulties, infections, rejection, and organ scarcity persist.

Impact:

• Lung transplantation has dramatically improved the prognosis for patients with end-stage lung disease.
• Despite advancements, challenges such as infection, rejection (including bronchiolitis obliterans), and limited organ availability remain significant hurdles.
• Continued research and innovation are crucial to overcome limitations and further enhance outcomes in lung transplantation.