Narrative review of the evolution of lung transplant

Abstract

Background: The first successful human lung transplant was performed approximately six decades ago, but evolution has been slow. It was not until the past two decades that lung transplantation became a more routine procedure with predictable outcomes.Methods: A comprehensive search of the medical literature using Ovid and PubMed search engines was conducted for progression of all aspects of lung transplantation, including surgical techniques, immunosuppression progression, donor selection criteria evolution, recipient criteria evolution, new technology used to support the patient prior and after transplant, along with donor organ management and the Lung Allocation Scoring (LAS) system variables and their impact on outcomes after lung transplantation.Conclusions: Advancement has been multifactorial in all phases of lung transplantation: in the preoperative phase with better selection criteria, better nutrition, and better pulmonary and physical rehabilitation; in the perioperative phase with improvement of surgical techniques, immunosuppression drugs, development of mechanical circulatory support, and preservation technology; and in the postoperative phase with better understanding of immune rejection and better management of long-term complications.All these progressions have been fundamental to the current success of lung transplantation.