Lung transplantation

The lung has historically been the most challenging of the human organs to be successfully transplanted in clinical practice. Since Hardy undertook the first single lung transplant in 1966, the operation has continued to be challenged by the frequent occurrence of bronchiolitis obliterans leading to the progressive onset of respiratory failure in the longer term. Demographically, the International Society for Heart and Lung Transplantation registry indicates that 78% of recipients in Europe are between 35 and 65 years of age with the majority receiving their transplant for COPD, cystic fibrosis or pulmonary fibrotic disease (Figure 14.1). Only 4.1% were re-transplant procedures, and 77% of recipients were discharged alive from hospital post-operatively. It is possible to transplant lungs singly (SLT) or sequentially as a bilateral lung transplant (BSLT) depending on patient characteristics and the nature of the pathological lung condition present. In some situations combined transplantation of the heart and lungs en bloc is necessary. A bilateral lung transplant is performed where it is clinically necessary to remove all native lung tissue. In the context of chronic lung sepsis in cystic fibrosis or bronchiectasis, single lung transplantation would fail as infection may cross-contaminate from the native remaining lung into the graft. Similarly, extensive destruction of both lungs in emphysema may suggest the need for bilateral replacement to avoid air trapping in a remaining overly compliant native lung, resulting in mediastinal shift and compromise of the contralateral graft. A single lung transplant is an attractive approach to the treatment of lung failure.