Review article
Challenges in Lung Transplatation
Feđa Džubur
Miroslav Samaržija
Abstract
Over the past 40 years, lung transplantation has become a worthwhile option for patients with a range of non-malignant lung diseases who have consumed all other options for conservative treatment. Although the first human lung transplant was performed 4 years before the first heart transplant, way back in 1963, there were no major developments in this field until the mid-1980s. The reasons were not of a technical nature, but rather a reflection of the need for better immunosuppressive drugs, or protocols for their use. Only with the introduction of ciclosporin into clinical practice, lung transplantation experienced a kind of renaissance and began to spread outside the USA in the 1990s. The most common indications for lung transplantation are chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, idiopathic pulmonary hypertension, cystic fibrosis and rare pulmonary entities such as lung sarcoidosis, alveolar microlithiasis, alveolar proteinosis, lymphangioleiomyomatosis. Since 2000, there has been a steady increase in lung transplant procedures with approximately 4,500 procedures per year in the last few years. The current limiting factor is the number of suitable donor lungs. Despite favorable results in recent years, lung transplantation is still burdened by mortality and morbidity rates associated with primary graft dysfunction (PGD), numerous infections, higher incidence of secondary malignancies, and chronic lung allograft dysfunction (CLAD). According to a recent report from the ISHLT Transplant Registry (International Society for Heart and Lung Transplantation), the average survival for adult recipients as of 2010 is 6.7 years. The average survival of patients transplanted in our institution is 96 months, which is higher than the ISHLT average. To improve treatment outcomes for chronic graft dysfunction, we need more enhanced diagnostics of chronic rejection and better immunosuppression protocols.
Keywords
lung transplantation; non-malignant lung diseases; chronic obstructive pulmonary disease; idiopathic pulmonary fibrosis; ciclosporin; immunosuppression
Hrčak ID:
315869
URI
Publication date:
9.4.2024.
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