Lung transplantation - A disease-specific approach

Advances in surgical technique, immunosuppression, and perioperative care have permitted successful application of lung transplantation to a variety of nonmalignant pulmonary disorders of the airways, lung parenchyma, and pulmonary vasculature. This option is available to selected candidates under the age of 65 years whose life expectancy and functional status are severely limited because of advanced lung disease but who remain ambulatory and free of significant comorbid disease. The majority of transplant recipients experience marked improvement in quality of life, but long-term survival remains an elusive goal for many patients. Five-year survival following lung transplantation is only 45%.(13) With the increasingly diverse indications for lung transplantation, it has become evident that the nature of the underlying disease process must be taken into account in many facets of candidate selection and recipient management. Ln this regard, an intimate appreciation of the natural history and prognostic indices of the individual disease states is essential in making appropriate decisions about the timing of transplantation. The decision to replace one or both lungs may rest on the particular pathophysiology of the underlying disease and the implications of leaving a native lung in place. Finally, the post-transplant course may be complicated by factors related to the native disease rather than those generic to transplantation and immunosuppression. This article provides a disease-specific approach to lung transplantation, highlighting issues particular to the primary diseases for which transplantation is commonly performed.