RECENT ADVANCES IN: LUNG TRANSPLANTATION

Abstract

After the successful human lung transplantation in 1963, big hopes were aroused among surgeons for the future of treating a lot of end stage pulmonary diseases. With the introduction of cyclosporine in 1983 it became obvious that early prevention of acute graft rejection is possible and efficient. The difficulty in providing suitable lung donors is a major problem facing that kind of treatment, a condition which led to the death of many patients awaiting lung transplantation. Restrictive lung diseases including idiopathic pulmonary fibrosis, pneumoconiosis and sarcoidosis, obstructive lung diseases including emphysema and cystic fibrosis, and pulmonary hypertension are all indications for lung transplantation. Donor organizations are responsible for providing donor lung grafts after donor evaluation, serological tests and serial bronchial cultures to them. Measurements of the donor lungs should be taken cautiously and compared to recipient chest SIZe. Contact between donor procurement team and transplantation team is essential to transport such graft in appropriate ischemic time. Graft preservational techniques and solutions are discussed (new ET-K, low-potassium dextran, and 20% blood-low-potassium dextran), together with the introduction of gene therapy beneficial in minimizing incidence of acute graft rejection and ischemic reperfusion InJUry. There are different types of lung transplantation namely: single lung transplantation, bilateral sequential lung, double en-block lung transplantation, heart-lung, and living donor lobar lung transplantation. Each type indicated for most appropriate disease category.