Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1995 Jan;221(1):14–28. doi: 10.1097/00000658-199501000-00003

Pulmonary transplantation.

R D Davis Jr 1, M K Pasque 1
PMCID: PMC1234491  PMID: 7826157

Abstract

OBJECTIVE: More than 2700 lung transplants have been performed since the initial clinical success in 1983. The evolution in the techniques of lung transplantation and patient management and the effects on results are reviewed. SUMMARY BACKGROUND DATA: Improvements in donor management, lung preservation, operative techniques, immunosuppression management, infection prophylaxis and treatment, rejection surveillance, and long-term follow-up have occurred in the decade following the first clinically successful lung transplant. A wider spectrum of diseases and patients treated with lung transplant have accentuated the shortage of suitable lung donors. The organ shortage has led to the use of marginal donors and a limited experience using living, related donors. METHODS: Changes in techniques and patient selection and management are reviewed and controversial issues and problems are highlighted. RESULTS: One-year survival of greater than 90% for single-lung transplant recipients and greater than 85% for bilateral lung transplant recipients have been achieved. Complications caused by airway complications has been reduced greatly. Obliterative bronchiolitis develops in 20% to 50% of long-term survivors and is the leading cause of morbidity and mortality after the first year after transplant. CONCLUSIONS: Lung transplantation has evolved into an effective therapy for a wide variety of causes of end-stage lung disease. Wider applicability requires solutions to the problems of donor shortage and development of obliterative bronchiolitis.

Full text

PDF
14

Images in this article

19Figure 1.
on p.19

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aiba M., Yokoyama Y., Snow T. R., Novitzky D., McKeown P. P. Effects of allopurinol pretreatment with pulmonary flush on lung preservation. J Heart Lung Transplant. 1992 Nov-Dec;11(6):1025–1030. [PubMed] [Google Scholar]
  2. Berry G. J., Brunt E. M., Chamberlain D., Hruban R. H., Sibley R. K., Stewart S., Tazelaar H. D. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant. 1990 Nov-Dec;9(6):593–601. [PubMed] [Google Scholar]
  3. Calhoon J. H., Grover F. L., Gibbons W. J., Bryan C. L., Levine S. M., Bailey S. R., Nichols L., Lum C., Trinkle J. K. Single lung transplantation. Alternative indications and technique. J Thorac Cardiovasc Surg. 1991 May;101(5):816–825. [PubMed] [Google Scholar]
  4. Cooper J. D., Billingham M., Egan T., Hertz M. I., Higenbottam T., Lynch J., Mauer J., Paradis I., Patterson G. A., Smith C. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993 Sep-Oct;12(5):713–716. [PubMed] [Google Scholar]
  5. Cooper J. D., Patterson G. A., Pohl M. S. Current status of lung transplantation--report of the St. Louis International Lung Transplant Registry. Clin Transpl. 1992:77–81. [PubMed] [Google Scholar]
  6. Cooper J. D., Patterson G. A., Trulock E. P. Results of single and bilateral lung transplantation in 131 consecutive recipients. Washington University Lung Transplant Group. J Thorac Cardiovasc Surg. 1994 Feb;107(2):460–471. [PubMed] [Google Scholar]
  7. D'Alonzo G. E., Barst R. J., Ayres S. M., Bergofsky E. H., Brundage B. H., Detre K. M., Fishman A. P., Goldring R. M., Groves B. M., Kernis J. T. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991 Sep 1;115(5):343–349. doi: 10.7326/0003-4819-115-5-343. [DOI] [PubMed] [Google Scholar]
  8. Date H., Matsumura A., Manchester J. K., Cooper J. M., Lowry O. H., Cooper J. D. Changes in alveolar oxygen and carbon dioxide concentration and oxygen consumption during lung preservation. The maintenance of aerobic metabolism during lung preservation. J Thorac Cardiovasc Surg. 1993 Mar;105(3):492–501. [PubMed] [Google Scholar]
  9. Davis R. D., Jr, Trulock E. P., Manley J., Pasque M. K., Sundaresan S., Cooper J. D., Patterson G. A. Differences in early results after single-lung transplantation. Washington University Lung Transplant Group. Ann Thorac Surg. 1994 Nov;58(5):1327–1335. doi: 10.1016/0003-4975(94)91907-0. [DOI] [PubMed] [Google Scholar]
  10. Dowling R. D., Zenati M., Yousem S. A., Pasculle A. W., Kormos R. L., Armitage J. A., Griffith B. P., Hardesty R. L. Donor-transmitted pneumonia in experimental lung allografts. Successful prevention with donor antibiotic therapy. J Thorac Cardiovasc Surg. 1992 Apr;103(4):767–772. [PubMed] [Google Scholar]
  11. Egan T. M., Ulicny K. S., Jr, Lambert C. J., Jr, Wilcox B. R. Effect of a free radical scavenger on cadaver lung transplantation. Ann Thorac Surg. 1993 Jun;55(6):1453–1459. doi: 10.1016/0003-4975(93)91087-4. [DOI] [PubMed] [Google Scholar]
  12. Griffith B. P., Bando K., Armitage J. M., Hattler B. G., Keenan R. J., Hardesty R. L., Komatsu K., Konishi H., Paradis I. L. Lung transplantation at the University of Pittsburgh. Clin Transpl. 1992:149–159. [PubMed] [Google Scholar]
  13. Griffith B. P., Magee M. J., Gonzalez I. F., Houel R., Armitage J. M., Hardesty R. L., Hattler B. G., Ferson P. F., Landreneau R. J., Keenan R. J. Anastomotic pitfalls in lung transplantation. J Thorac Cardiovasc Surg. 1994 Mar;107(3):743–754. [PubMed] [Google Scholar]
  14. HARDY J. D., WEBB W. R., DALTON M. L., Jr, WALKER G. R., Jr LUNG HOMOTRANSPLANTATION IN MAN. JAMA. 1963 Dec 21;186:1065–1074. doi: 10.1001/jama.1963.63710120001010. [DOI] [PubMed] [Google Scholar]
  15. Hardesty R. L., Aeba R., Armitage J. M., Kormos R. L., Griffith B. P. A clinical trial of University of Wisconsin solution for pulmonary preservation. J Thorac Cardiovasc Surg. 1993 Apr;105(4):660–666. [PubMed] [Google Scholar]
  16. Hayden A. M., Robert R. C., Kriett J. M., Smith C. M., Nicholson K., Jamieson S. W. Primary diagnosis predicts prognosis of lung transplant candidates. Transplantation. 1993 May;55(5):1048–1050. doi: 10.1097/00007890-199305000-00019. [DOI] [PubMed] [Google Scholar]
  17. Haydock D. A., Trulock E. P., Kaiser L. R., Knight S. R., Pasque M. K., Cooper J. D. Management of dysfunction in the transplanted lung: experience with 7 clinical cases. Washington University Lung Transplant Group. Ann Thorac Surg. 1992 Apr;53(4):635–641. doi: 10.1016/0003-4975(92)90324-w. [DOI] [PubMed] [Google Scholar]
  18. Inui K., Schäfers H. J., Aoki M., Wada H., Becker V., Ongsiek B., Haverich A. Effect of methylprednisolone and prostacyclin on bronchial perfusion in lung transplantation. Ann Thorac Surg. 1993 Feb;55(2):464–469. doi: 10.1016/0003-4975(93)91020-n. [DOI] [PubMed] [Google Scholar]
  19. Kerem E., Reisman J., Corey M., Canny G. J., Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med. 1992 Apr 30;326(18):1187–1191. doi: 10.1056/NEJM199204303261804. [DOI] [PubMed] [Google Scholar]
  20. Kramer M. R., Stoehr C., Lewiston N. J., Starnes V. A., Theodore J. Trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis carinii infections in heart-lung and lung transplantation--how effective and for how long? Transplantation. 1992 Mar;53(3):586–589. doi: 10.1097/00007890-199203000-00019. [DOI] [PubMed] [Google Scholar]
  21. Lambert C. J., Jr, Egan T. M. Optimal timing of administration of a free radical scavenger in lung preservation. Transplantation. 1992 Aug;54(2):205–209. doi: 10.1097/00007890-199208000-00003. [DOI] [PubMed] [Google Scholar]
  22. Levy R. D., Ernst P., Levine S. M., Shennib H., Anzueto A., Bryan C. L., Calhoon J. H., Trinkle J. K., Jenkinson S. G., Gibbons W. J. Exercise performance after lung transplantation. J Heart Lung Transplant. 1993 Jan-Feb;12(1 Pt 1):27–33. [PubMed] [Google Scholar]
  23. Mal H., Andreassian B., Pamela F., Duchatelle J. P., Rondeau E., Dubois F., Baldeyrou P., Kitzis M., Sleiman C., Pariente R. Unilateral lung transplantation in end-stage pulmonary emphysema. Am Rev Respir Dis. 1989 Sep;140(3):797–802. doi: 10.1164/ajrccm/140.3.797. [DOI] [PubMed] [Google Scholar]
  24. Miller J. D., DeHoyos A. An evaluation of the role of omentopexy and of early perioperative corticosteroid administration in clinical lung transplantation. The University of Toronto and Washington University Lung Transplant Programs. J Thorac Cardiovasc Surg. 1993 Feb;105(2):247–252. [PubMed] [Google Scholar]
  25. Novick R. J., Andréassian B., Schäfers H. J., Haverich A., Patterson G. A., Kaye M. P., Menkis A. H., McKenzie F. N. Pulmonary retransplantation for obliterative bronchiolitis. Intermediate-term results of a North American-European series. J Thorac Cardiovasc Surg. 1994 Mar;107(3):755–763. [PubMed] [Google Scholar]
  26. Novick R. J., Menkis A. H., McKenzie F. N. New trends in lung preservation: a collective review. J Heart Lung Transplant. 1992 Mar-Apr;11(2 Pt 1):377–392. [PubMed] [Google Scholar]
  27. Pasque M. K., Cooper J. D., Kaiser L. R., Haydock D. A., Triantafillou A., Trulock E. P. Improved technique for bilateral lung transplantation: rationale and initial clinical experience. Ann Thorac Surg. 1990 May;49(5):785–791. doi: 10.1016/0003-4975(90)90023-y. [DOI] [PubMed] [Google Scholar]
  28. Pasque M. K., Kaiser L. R., Dresler C. M., Trulock E., Triantafillou A. N., Cooper J. D. Single lung transplantation for pulmonary hypertension. Technical aspects and immediate hemodynamic results. J Thorac Cardiovasc Surg. 1992 Mar;103(3):475–482. [PubMed] [Google Scholar]
  29. Puskas J. D., Winton T. L., Miller J. D., Scavuzzo M., Patterson G. A. Unilateral donor lung dysfunction does not preclude successful contralateral single lung transplantation. J Thorac Cardiovasc Surg. 1992 May;103(5):1015–1018. [PubMed] [Google Scholar]
  30. Ross D. J., Waters P. F., Mohsenifar Z., Belman M. J., Kass R. M., Koerner S. K. Hemodynamic responses to exercise after lung transplantation. Chest. 1993 Jan;103(1):46–53. doi: 10.1378/chest.103.1.46. [DOI] [PubMed] [Google Scholar]
  31. Schueler S., De Valeria P. A., Hatanaka M., Cameron D. E., Bando K., Zeebley M., Hutchins G. M., Reitz B. A., Baumgartner W. A. Successful twenty-four-hour lung preservation with donor core cooling and leukocyte depletion in an orthotopic double lung transplantation model. J Thorac Cardiovasc Surg. 1992 Jul;104(1):73–82. [PubMed] [Google Scholar]
  32. Shennib H., Massard G. Airway complications in lung transplantation. Ann Thorac Surg. 1994 Feb;57(2):506–511. doi: 10.1016/0003-4975(94)91038-3. [DOI] [PubMed] [Google Scholar]
  33. Skwarski K., MacNee W., Wraith P. K., Sliwinski P., Zielinski J. Predictors of survival in patients with chronic obstructive pulmonary disease treated with long-term oxygen therapy. Chest. 1991 Dec;100(6):1522–1527. doi: 10.1378/chest.100.6.1522. [DOI] [PubMed] [Google Scholar]
  34. Snell G. I., de Hoyos A., Krajden M., Winton T., Maurer J. R. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest. 1993 Feb;103(2):466–471. doi: 10.1378/chest.103.2.466. [DOI] [PubMed] [Google Scholar]
  35. Sundaresan S., Trachiotis G. D., Aoe M., Patterson G. A., Cooper J. D. Donor lung procurement: assessment and operative technique. Ann Thorac Surg. 1993 Dec;56(6):1409–1413. doi: 10.1016/0003-4975(93)90699-i. [DOI] [PubMed] [Google Scholar]
  36. Tazelaar H. D., Nilsson F. N., Rinaldi M., Murtaugh P., McDougall J. C., McGregor C. G. The sensitivity of transbronchial biopsy for the diagnosis of acute lung rejection. J Thorac Cardiovasc Surg. 1993 Apr;105(4):674–678. [PubMed] [Google Scholar]
  37. Trulock E. P. Management of lung transplant rejection. Chest. 1993 May;103(5):1566–1576. doi: 10.1378/chest.103.5.1566. [DOI] [PubMed] [Google Scholar]
  38. Veith F. J., Richards K. Improved technic for canine lung transplantation. Ann Surg. 1970 Apr;171(4):553–558. doi: 10.1097/00000658-197004000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Wang L. S., Nakamoto K., Hsieh C. M., Miyoshi S., Cooper J. D. Influence of temperature of flushing solution on lung preservation. Ann Thorac Surg. 1993 Mar;55(3):711–715. doi: 10.1016/0003-4975(93)90280-u. [DOI] [PubMed] [Google Scholar]
  40. Williams T. J., Patterson G. A., McClean P. A., Zamel N., Maurer J. R. Maximal exercise testing in single and double lung transplant recipients. Am Rev Respir Dis. 1992 Jan;145(1):101–105. doi: 10.1164/ajrccm/145.1.101. [DOI] [PubMed] [Google Scholar]
  41. de Hoyos A. L., Patterson G. A., Maurer J. R., Ramirez J. C., Miller J. D., Winton T. L. Pulmonary transplantation. Early and late results. The Toronto Lung Transplant Group. J Thorac Cardiovasc Surg. 1992 Feb;103(2):295–306. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES