CHEST Guidelines-The-Future-of-Lung-Transplantation_2018

The-Future-of-Lung-Transplantation_2018_chest

Pdf Summary

The field of lung transplantation has advanced significantly, yet high morbidity and mortality levels persist compared to other organ transplants. Future progress in the field depends on overcoming challenges related to donor shortages, candidate selection, primary graft dysfunction (PGD), and chronic lung allograft dysfunction (CLAD). Despite nearly 4,000 lung transplants being performed worldwide annually, donor shortages result in significant wait-list mortality, with 10% to 13% of candidates dying while waiting for a suitable donor.<br /><br />Strategies to address the donor shortage include using more donors after circulatory death, extended donor criteria, ex vivo lung perfusion (EVLP) technology to assess and potentially enhance marginal lungs, and bioengineered lungs. EVLP allows for evaluating lungs of uncertain quality by ventilating and perfusing them outside the donor's body. This approach could also serve as a platform for therapeutic interventions, potentially decreasing PGD by improving donor lung quality pre-transplant.<br /><br />To improve recipient selection, the focus is on early referrals and optimizing pre-existing conditions in candidates to minimize post-transplant complications. Efforts like improved drugs for lung diseases could delay the need for a transplant, reducing wait time and potentially improving outcomes.<br /><br />Addressing PGD, the leading cause of early mortality, involves exploring inflammation pathways for new therapies. For CLAD, which largely impacts long-term survival, innovations in treatments and improved diagnostic tools are essential for detecting and preventing chronic rejection.<br /><br />Overall, the future of lung transplantation looks promising with technological advancements and expanded criteria, alongside therapeutic innovations for managing chronic infections and reducing rejection, all potentially enhancing the field's success and reducing mortality rates.

Keywords

lung transplantation

morbidity

mortality

donor shortage

primary graft dysfunction

chronic lung allograft dysfunction

ex vivo lung perfusion

bioengineered lungs

recipient selection

therapeutic innovations