Lung transplantation

Searl, Cait P. and Clark, Stephen (2009) Lung transplantation. In: Core Topics in Thoracic Anesthesia. Cambridge University Press, pp. 91-98. ISBN 9780521867122

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The lung has historically been the most challenging of the human organs to be successfully transplanted in clinical practice. Since Hardy undertook the first single lung transplant in 1966, the operation has continued to be challenged by the frequent occurrence of bronchiolitis obliterans leading to the progressive onset of respiratory failure in the longer term. Demographically, the International Society for Heart and Lung Transplantation registry indicates that 78% of recipients in Europe are between 35 and 65 years of age with the majority receiving their transplant for COPD, cystic fibrosis or pulmonary fibrotic disease (Figure 14.1). Only 4.1% were re-transplant procedures, and 77% of recipients were discharged alive from hospital post-operatively. It is possible to transplant lungs singly (SLT) or sequentially as a bilateral lung transplant (BSLT) depending on patient characteristics and the nature of the pathological lung condition present. In some situations combined transplantation of the heart and lungs en bloc is necessary. A bilateral lung transplant is performed where it is clinically necessary to remove all native lung tissue. In the context of chronic lung sepsis in cystic fibrosis or bronchiectasis, single lung transplantation would fail as infection may cross-contaminate from the native remaining lung into the graft. Similarly, extensive destruction of both lungs in emphysema may suggest the need for bilateral replacement to avoid air trapping in a remaining overly compliant native lung, resulting in mediastinal shift and compromise of the contralateral graft. A single lung transplant is an attractive approach to the treatment of lung failure.

Item Type: Book Section
Uncontrolled Keywords: airway obstruction, bronchial blockers, double lumenendobronchial tube, fiberoptic bronchoscope guidance, tracheostomy, lung isolation, univent torque control blocker, hypoxia
Subjects: B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Applied Sciences
Depositing User: Paul Burns
Date Deposited: 15 Jan 2019 11:01
Last Modified: 11 Oct 2019 14:33

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