Updates in Lung Transplantation.
Clinical Transplants 2012, Chapter 16
The past two years have seen major advances in the lung transplant (LTX) field. In 2010, for the first time, over 3500 lungs were reported to the International Society for Heart and Lung Transplantation Registry. Widening application of extracorporeal life support as a bridge to transplant, or as intra- or postoperative support, has allowed transplantation of critically ill candidates with end-stage pulmonary parenchymal or vascular disease. Ex-vivo lung perfusion expanded the donor pool, allowing transplant teams time to evaluate non-ideal lungs or those from donation after cardiac death donors. While increased activity involving higher risk recipients and donors has resulted in acceptable survival, chronic rejection, or bronchiolitis obliterans syndrome, still limits long-term survival. Emerging histopathologic, radiographic, and physiologic evidence has led to the recognition that BOS is not the only form of chronic lung failure and to the development of a new classification system: chronic lung allograft dysfunction (CLAD). Both allo- and autoimmune mechanisms, as well as nonimmune mechanisms, have been identified in CLAD development. Immunosuppressive and immune modulating agents, recently evaluated in randomized controlled trials, have shown promise in CLAD therapy. This review will outline some of the key advances in LTX in the past year.