Lung transplantation for interstitial lung disease

Area of Science:

• Pulmonology
• Transplant Surgery

Background:

• Interstitial lung diseases (ILDs) represent the most frequent indication for lung transplantation globally.
• Older age and frailty are common in lung transplant candidates with idiopathic pulmonary fibrosis, necessitating pulmonary rehabilitation.
• Many ILD patients who could benefit from lung transplantation are referred late or not at all.

Purpose of the Study:

• To highlight the challenges and considerations in lung transplantation for ILD patients.
• To emphasize the importance of multidisciplinary assessment and pulmonary rehabilitation.
• To discuss the evolving evidence for lung transplantation in rare ILDs and the role of palliative care.

Main Methods:

• Review of current practices and evidence in lung transplantation for ILDs.
• Analysis of factors influencing outcomes, including age, comorbidities, and organ availability.
• Consideration of single versus bilateral lung transplant decisions.

Main Results:

• Increasing age and comorbidities present significant challenges in ILD lung transplantation.
• Donor lung sizing and the risk-benefit analysis of transplant type are critical considerations.
• Evidence is emerging for lung transplantation in rarer ILDs, such as those associated with surfactant protein deficiencies and TERT mutations.

Conclusions:

• Lung transplantation for ILD is complex, requiring careful management of patient factors and surgical decisions.
• Palliative care is essential for patients on the lung transplant waiting list to manage symptoms and improve quality of life.
• Addressing organ shortages and optimizing patient selection remain critical challenges in ILD lung transplantation.