Lung transplantation

Abstract

Since 1983, when the first successful lung transplant was done by The Toronto Lung Transplant Group, more than 2330 transplants in over 76 centers have been performed worldwide. The overall 3-year survival rate in lung transplantation is 72% (1 year), 67% (2 years), and 62% (3 years) at our institution, compared with 68% (1 year), 59% (2 years), and 54% (3 years) worldwide. SSLT and double-lung transplants have a 3-year survival rate of 67% compared with 53% for single-lung transplants. SSLT is the procedure of choice for double-lung replacement and is best for patients with preserved cardiac function and end-stage emphysema, cystic fibrosis, and bilateral pulmonary sepsis. Although the technique of SSLT has obviated the mandatory requirement for CPB in en bloc double-lung transplantation, intraoperative critical periods that may precipitate the need of CPB are during postinduction, single-lung ventilation, pulmonary artery clamping, implantation of donor lungs, and reperfusion and ventilation of the grafts. Vigilant anesthetic monitoring and management are essential for optimal care of these patients. Lung transplantation still faces a number of problems, especially infection and rejection; however, results are very gratifying in this group of moribund patients. Future trends and research development in lung transplantation are encompassed in the intraoperative assessment of right ventricular function, donor lung preservation and reperfusion, decrease in risk or requirement of CPB, postoperative analgesia control, prevention of rejection and infection, and xenograft transplantation.