[Lung transplantation]

Abstract

Lung transplantation is indicated for patients with cystic fibrosis, emphysema, pulmonary fibrosis or pulmonary hypertension whose life expectancy is less than two years. Criteria of severity are detailed. Three types of transplantation can be proposed: single lung transplant for fibrosis and dry emphysema; bilateral lung transplant for cystic fibrosis, and certain types of emphysema and pulmonary hypertension; heart-lung transplant for pulmonary hypertension and Eisenmenger syndrome. Due to insufficient supply of donor organs, one quarter of the candidates die on the waiting list and the limit for inscription is often 60 years. Postoperative mortality at two months is about 15% and is related to graft dysfunction, infection, bronchial complications,... Acute rejection usually occurs during the first year. Chronic rejection is expressed by obliterating bronchiolitis, the leading cause of death after one year. There is a risk of cancer (EBV-induced lymphoproliferative syndromes and skin cancer). Five-year survival is still only about 50%. Immunosuppressor treatments still cause numerous adverse effects (hypertension, renal toxicity...); function and quality-of-life have however greatly improved.