Disease-specific approach to lung transplantation

Abstract

Purpose of review: The present review provides an update on the recent literature regarding disease-specific issues in lung transplantation. Some of the published data will help refine previously published candidate selection criteria and provide evidence-based data for choice of procedures.

Recent findings: Recent studies on lung transplant outcomes in older patients underline that satisfactory results can be obtained in patients older than 60 years but not in patients older than 70 years. Data from two large registry-based studies indicate that bilateral lung transplantation in patients with chronic obstructive pulmonary disease confers significantly longer survival than single lung transplantation, especially in patients younger than 60 years. Mathematical models to estimate survival benefit in chronic obstructive pulmonary disease lung transplant candidates have been developed and are being validated. The impact of Bcc colonization in cystic fibrosis patients on outcome has been nuanced; thus, cystic fibrosis lung transplant candidates colonized by particular Bcc strains may be transplanted with good outcomes. Novel surgical approaches to peculiar situations in end-stage cystic fibrosis have been described. Candidate selection criteria for retransplantation procedures have further been clarified.

Summary: This article attempts to provide an overview of some of the currently important topics for clinicians involved in referring and evaluating patients with end-stage lung disease for lung transplantation in 2009.