Medicus, Vol. 27 No. 2 Sumamed, 2018.
Review article
Lung Transplantation
Gordana Pavliša
Feđa Džubur
Ana Hećimović
Gzim Redžepi
Miroslav Samaržija
Abstract
Lung transplantation has become a life-saving procedure for the patients with a variety of end-stage pulmonary diseases. The most common indications for lung transplantation are: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency related emphysema, and primary pulmonary hypertension. Patients whose life expectancy is predicted at less than 50% over the next 24-36 months despite optimal and maximal medical management and/or if they have class III and IV symptoms according to the New York Heart Association (NYHA) association should be referred for a transplant assessment. There are several types of lung transplantation procedures: single-lung, double-lung, lobar lung, and heart-lung transplantation. Lung transplant recipients are at increased risk for different types of complications. Infectious complications are common due to a high level of immunosuppression, continuous contact of the transplanted organ with the environment along with the loss of defence mechanisms, including the mucociliary clearance, cough reflex and lymphatic drainage. Primary graft dysfunction may occur within the first 24 hours after the transplantation. It can result from allograft injury during transplant process (explantation and preservation of donor organ, cold ischemic storage) or from ischemia-reperfusion injury of the allograft after implantation. Despite improved immunosuppressive regimes, acute rejection affects more than 30% of lung transplant recipients within the first year after transplant. We distinguish acute cellular, humoral and hyperacute rejection. After the first transplantation year, chronic rejection is the primary cause of mortality in lung transplant recipients, accounting for approximately 40% of deaths. There are two types of chronic lung rejection phenotypes: bronchiolitis obliterans syndrome and restrictive allograft syndrome. The key to successful treatment of post-transplant complications is prompt patient evaluation which often includes invasive diagnostic testing to assure appropriate therapeutic approach. Croatian transplantation programme exists since 2011. Lung transplantation has performed in 67 patients, lung and heart transplantation in two patients, and lung re-transplantation in one patient.
Keywords
lung transplantation; indications; primary allograft dysfunction; acute allograft rejection; chronic allograft rejection
Hrčak ID:
214616
URI
Publication date:
31.10.2018.
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