From the Guidelines
Lung transplantation is a viable option for patients with end-stage pulmonary disease, including those with pulmonary arterial hypertension (PAH) and chronic obstructive pulmonary disease (COPD), with recent advances showing improved survival rates and quality of life.
Recent Advances in Lung Transplantation
- The overall 5-year survival following transplantation for PAH has increased to 52-75% and to 45-66% at 10 years, with evidence of continued good quality of life 1.
- Bilateral lung transplantation may be a better option than single lung transplantation, as it is associated with better long-term outcomes, at least among patients younger than 60 years 1.
- Lung transplantation can improve long-term outcomes for patients with end-stage lung fibrosis, including those with systemic sclerosis (SSc), with survival rates of approximately 81% and 66% at 1 year and 5 years, respectively 1.
Transplantation Procedures
- The type of transplantation procedure for patients with PAH includes single lung transplantation (SLT), bilateral lung transplantation (BLT), and combined heart-lung transplantation (HLT) 1.
- The decision to perform HLT in PAH patients is based on the severity of cardiac decompensation, with the combined procedure generally reserved for patients with intractable right heart failure 1.
- BLT may offer a better long-term posttransplant survival than SLT, but the optimal transplant procedure for patients with PAH will depend on individual patient characteristics and the availability of appropriate organs for transplantation 1.
Patient Selection and Timing of Referral
- Patients with PAH should be referred for lung transplantation when they have an unacceptable response to PAH therapies, with the timing of referral dependent on local practices and organ availability 1.
- Patients with SSc-ILD should be considered for lung transplantation in cases of severe disease or poor prognosis, with outcomes after lung transplantation comparable to those in other chronic diseases in age- and sex-matched patients 1.
From the Research
Recent Advances in Lung Transplantation
- Lung transplantation has become a preferred treatment option for end-stage pulmonary diseases, with significant advances in technique and understanding of transplant immunology and microbiology 2.
- Despite these advances, challenges such as donor shortage, primary graft dysfunction, and chronic lung allograft dysfunction remain to be overcome 3, 4.
- Recent developments in treatment after lung transplantation include the use of modern immunosuppressive agents, which have improved outcomes and increased 5-year survival rates to over 70% 5.
- Advances in donor lung preservation, extracorporeal membrane oxygenation, and intensive care medicine have also contributed to improved results in lung transplantation 6.
Current Challenges and Future Directions
- Donor shortage continues to be a major limitation, with efforts to expand the donor pool and increase the use of marginal donors, living lobar and split lung donor techniques, and nonheartbeating donors 4, 2.
- Chronic lung allograft dysfunction remains a significant challenge, with no well-established therapy available, and research focused on developing novel strategies for its prevention and treatment 3, 5.
- New technologies such as ex vivo lung perfusion and bioengineered lungs, as well as cutting-edge innovations like novel biomarkers and new ways to treat infected donors, are being explored to improve lung transplantation outcomes 4.
- Xenotransplantation and lung bioengineering may become available in the future as alternatives to allotransplantation, offering new hope for patients with end-stage lung disease 6.