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PERSPECTIVE
Year : 2001  |  Volume : 2  |  Issue : 2  |  Page : 53-56

Lung transplantation


Department of Thoracic Surgery, University Lyon Sud, L. Pradel Hospital, Lyon-, France

Correspondence Address:
Duilio Divisi
Circonvallazione Ragusa 39, 164100 Teramo
France
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Source of Support: None, Conflict of Interest: None


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Transplantation of organs is the great adventure of this century. Alexis Carrel developed methods of joining blood vessels, which made the transplantation of organs feasible. Demikhov performed the first intra-thoracic canine lung and heart transplantation in the 1940s. In the early 1950s, Metras demonstrated that canine lung transplantation is technical feasible. In 1963, the first human lung transplant was performed and during the subsequent 15 years, about 40 clinical lung transplants were performed around the world. Successful lung transplant was achieved in 1982. The discovery of cyclosporine and its use as an immunosuppressant drug permitted prolonged survival in all transplanted organs especially in lung transplants. At present, lung transplantation is successfully used worldwide The remarkable progress and improved results in lung transplantation is due to superior immunosuppression strategies, improved donor and recipient selection, new antibiotics, improved strategies of preservation using prostaglandine E1 have decreased reperfusion injury, and prevention of post-operative sepsis due to bacterial, fungal, viral and parasitic infections, especially in cystic fibrosis. Heart-lung transplant is indicated for patients with pulmonary vascular disease, congenital heart disease and cystic fibrosis. These represent 72% of indications. Double lung transplant is reserved for bilateral lung anomalies without consequences on cardiac function: infectious diseases, bronchiectasies, cystic fibrosis, lymphangioleiomyomatosis, bronchioloalveolar carcininoma, and emphysema. Single lung transplant is reserved for patients who have no infection of their native lungs such as primary pulmonary hypertension without cardiac insufficiency, idiopathic fibrosis, histiocytosis X and emphysema without distension. The operative mortality rate is in the range of 10%. The five-year survival rate is about 60%. Despite advances in treatment of complications such as infection and chronic rejection, they are still responsible for half of the deaths after transplantation. However, in young patients with end-stage lung disease, lung transplantation is the sole treatment.


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