Developments in lung transplantation over the past decade

Abstract

With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

Lung transplantation for patients with severe COVID-19

“…Lung transplantation is a life-saving treatment for a variety of end-stage lung diseases (5). Annually, more than 2,700 lung transplants are performed in the United States with a 1year survival of over 90% and a 3-year survival of over 75% (www.srtr.org).…”

Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries

“…Lung transplantation is used to treat a variety of end-stage lung diseases; however, patients with acute lung injury due to infectious causes are generally not considered for transplantation. 1 Although sporadic cases of lung transplantation for COVID-19-associated acute respiratory distress syndrome (ARDS) have been reported, 2 , 3 , 4 insufficient data are available to inform selection criteria for potential recipients, the optimal timing of transplantation, and outcomes after transplantation. Additionally, several unaddressed concerns limit the use of lung transplantation as a therapy for patients with severe ARDS secondary to COVID-19.…”

In Vitro Lung Models and Their Application to Study SARS-CoV-2 Pathogenesis and Disease

“…While ex vivo platforms and tissue explants authentically portray the pathophysiology of lung diseases, these approaches are also associated with a number of drawbacks ( Table 2 ). Even though only 15–25% of the total lung donor pool meet the criteria for transplantation [ 120 , 121 ]—i.e., an estimated 75–85% would theoretically be available for EVLPs—this does not mitigate the fact that the number of suitable lungs for EVLP is still fairly small as a result of geographical, financial and ethical limitations. Additionally, reproducibility is constrained due to the significant heterogeneity in human lung tissue (e.g., sex, age, smoking history, underlying diseases of donor) and pre-procurement variables (e.g., trauma, ventilator-induced lung injury and ventilator-associated pneumonia).…”