ABSTRACT

Lung transplantation has become a real and effective option to treat several end-stage lung diseases. This review analyzes the sequence of the transplantation events: The recipient selection, the donation process, the evaluation of the donor, the surgical act, the immediate postsurgical management and the follow-up to detect the most important complications such as infection and rejection. In addition, some physiologic results of patients transplanted in Mexico are discussed.

KEYWORDS

Lung transplantation, donor evaluation, survival, surgical treatment, transplantation rejection.

REFERENCES

1. Hardy JD, Webb WR, Dalton ML, et al. Homotransplantation in man. JAMA 1963; 186: 1065-1074.

2. Toronto Lung Transplantation Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986; 314: 1140-1145.

3. Trulock EP, Edwards LB, Taylor DO, Boucek MM, Keck BM, Hertz MI. Registry of the International Society for Heart and Lung Transplantation: Twenty-second Official Adult Lung and Heart–Lung Transplant Report-2005. J Heart Lung Transplant 2005; 24: 945-982.

4. International Guidelines for the Selection of Lung Transplant Candidates. Am J Respir Crit Care Med 1998; 158: 335-339.

5. Grupo de Trabajo de la SEPAR. Trasplante pulmonar. Arch Bronconeumol 2001; 37: 307-315.

6. Glanville AR, Estenne M. Indications, patient selection and timing of referral for lung transplantation. Eur Respir J 2003; 22: 845-852.

7. Kerem E, Reisman J, Corey M, Canny GT, Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med 1992; 326: 1187-1191.

8. Doershuk CF, Stern RC. Timing of referral for lung transplantation for cystic fibrosis. Overemphasis on FEV1 may adversely affect overall survival. Chest 1999; 115: 782-787.

9. Yankaskas JR, Mallory GB, and the Consensus Committee. Lung transplantation in cystic fibrosis. Consensus Conference Statement. Chest 1998; 113: 217-226.

10. Aurora P, Whitehead B, Wade A, Bowyer J, Whitmore P, Rees PG, et al. Lung transplantation and life extension in children with cystic fibrosis. Lancet 1999; 354: 1591-1593.

11. Meier-Sydow J, Weiss SM, Buhl R, Rust M, Raghu G. Idiopathic pulmonary fibrosis: current clinical concepts and challenges in management. Semin Respir Crit Care Med 1994; 15: 77-96.

12. Hosenpud JD, Bennett LE, Keck BM, Edwards EB, Novick RJ. Effect of diagnosis on survival benefit of lung transplantation for endstage lung disease. Lancet 1998; 351: 24-27.

13. Orens JB, Boehler A, de Perrot M, Estenne M, Glanville AR, Keshavjee S, Kotloff R, Morton J, Studer SM, Van Raemdonck D, Waddel T, Snell GI. A Review of Lung Transplant Donor Acceptability Criteria. The Journal of Heart and Lung Transplantation 2003; 22: 1183-1200.

14. Garrity ER. Pre-transplant evaluation of the donor/organ procurement. In: Norman DJ, Suki WN, editors. Primer on Transplantation first edition. Thorofare, N.J. American Society of Transplant Physicians, 1998: 499-505.

15. Myoshi S, Trulock EP, Shaefers H, Hsie C, Patterson GA, Cooper JD. Cardiopulmonary exercise testing after single and double lung transplantation. Chest 1990; 97: 1130-6.

16. United Network for Organ Sharing. Guidelines for multiorgan donor management and procurement. UNOS Update 1993: 14-5.

17. Harjula A, Baldwin JC, Starnes VA, et al. Proper donor selection for heart-lung transplantation. The Stanford experience. J Thorac Cardiovasc Surg 1987; 94: 874-80.

18. Frost AE. Donor criteria and evaluation. Clin Chest Med 1997; 18: 231-7.

19. Cooper JD. The lung donor: special considerations. Transplant Proc 1988; 20: 17-8.

20. Griffith BP, Zenati M. The pulmonary donor. Clin Chest Med 1990; 11: 217-26.

21. Winton TL, Miller JD, Scavuzzo M, et al. Donor selection for pulmonary transplantation. Transplant Proc 1991; 23: 2472-4.

22. Egan T. Selection and management of the lung donor. In: Patterson GA, Couraud L, eds. Current topics in general thoracic surgery. Amsterdam: Elsevier, 1995: 103-15.

23. Egan T, Boychuk JE, Rosato K, et al. Whence the lungs? A study to assess suitability of donor lungs for transplantation. Transplantation 1992; 53: 420-2.

24. Riou B, Guesde R, Jacquens Y, et al. Fiberoptic bronchoscopy in brain-dead organ donors. Am J Respir Crit Care Med 1994; 150: 558-60.

25. Lillehei CW, Shamberger RC, Mayer JE, Burke RP, Koka BV, Arnold J, et al. Size disparity in pediatric lung transplantation. J Pediatr Surg 1994; 29: 1152-5.

26. Massard G, Badier M, Guillot C, Reynaud M, Thomas P, Giudicelli R. Lung size matching for double lung transplantation based on the submammary thoracic perimeter. Accuracy and functional results. J Thorac Cardiovasc Surg 1993; 105: 9-14.

27. Miyoshi S, Schaefers HJ, Trulock EP, Yamazaki F, Schreinemakers H, Patterson GA, et al. Donor selection for single and double lung transplantation. Chest size matching and other factors influencing post-transplantation vital capacity. Chest 1990; 98: 308-13.

28. Park SJ, Houck J, Pifarre R, Sullivan H, Garrity ER, Kim SY, et al. Optimal size matching in single lung transplantation. J Heart Lung Transplant 1995; 14: 671-5.

29. Hayden AM, Scarlett MV, Fox K. Relationship between donor/recipient lung size mismatch and functional outcome in single lung transplantation for COPD. J Transplant Coord 1996; 6: 155-8.

30. Sundaresan S, Trachiotis GD, Aoe M, Patterson GA, Cooper JD. Donor lung procurement: assessment and operative technique. Ann Thorac Surg 1993; 56: 1409-13.

31. Pierre AF, Sekine Y, Hutcheon M, Waddell TK, Keshavjee S. Marginal lung donors: a reassessment. J Thorac Cardiovasc Surg 2002; 123(3): 421-8.

32. Harjula A, Baldwin JC, Starnes VA, et al. Proper donor selection for heart-lung transplantation. The Stanford experience. J Thorac Cardiovasc Surg 1987; 94: 874-80.

33. Pennefather SH, Bullock RE, Dark JH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation 1993; 56: 1418-22.

34. Waller DA, Bennett MK, Corris PA, Dark JH. Donor acquired fat embolism causing primary organ failure after lung transplantation. Ann Thorac Surg 1995; 59: 1565-6.

35. Nakhleh R, Higgins RS. Donor cerebral tissue pulmonary emboli in a functioning transplanted lung. Clin Transplant 1998; 12: 504-7.

36. Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000; 19: 1199-204.

37. Eastlund T. The histo-blood group ABO system and tissue transplantation. Transfusion 1998; 38: 975-88.

38. Starzl TE, Tzakis A, Makowka L, et al. The definition of ABO factors in transplantation: relation to other humoral antibody states. Transplant Proc 1987; 19: 4492-7.

39. Hunt BJ, Yacoub M, Amin S, et al. Induction of red blood cell destruction by graft-derived antibodies after minor ABO-mismatched heart and lung transplantation. Transplantation 1988; 1988: 246-9.

40. Ciulli F, Tamm M, Dennis CM, et al. Donor transmitted bacterial infection after lung transplantation. Transplant Proc 1993; 25: 1155.

41. Matuschak GM. Optimizing ventilatory support of the potential organ donor during evolving brain death: Maximizing lung availability for transplantation. Crit Care Med 2006; 34(2): 548-9.

42. de Perrot M, Weder W, Patterson GA, Keshavjee S. Strategies to increase limited donor resources. Eur Respir J 2004; 23: 477-482.

43. Lau CL, Patterson GA, Palmer SM. Critical care aspects of lung transplantation. J Intensive Care Med. 2004; 19: 83-104.

44. Meyers BF, Lynch JP, Trulock EP, et al. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience. J Thorac Cardiovasc Surg 2000; 120: 99-107.

45. Davis RD, Trulock EP, Manley J, et al. Differences in early results after single lung transplantation. Ann Thorac Surg 1994; 58: 1327-1335.

46. Cassivi SD, Meyers BF, Battafarano RJ, et al. Thirteenyear experience in lung transplantation for emphysema. Ann Thorac Surg 2002; 74: 1663-1669.

47. Hadjiliadis D, Davis RD, Palmer SM. Is transplant operation important in determining post-transplant risk of bronchiolitis obliterans syndrome in lung transplant recipients? Chest 2002; 122: 1168-1175.

48. Starnes VA, Bowdish ME, Woo MS, Barbers RG, Schenkel FA, Horn MV, Pessotto R, Sievers EM, Baker CJ, Cohen RG, et al. A decade of living lobar lung transplantation: recipient outcomes. J Cardiovasc Surg (Torino) 2004; 127: 114-122.

49. Ahya VN, Kawut SM. Noninfectious Pulmonary Complications After Lung Transplantation. Clin Chest Med 2005; 26: 613-622.

50. Van Muylem A, Melot C, Antoine M, et al. Role of pulmonary function in the detection of allograft dysfunction after heart-lung transplantation. Thorax 1997; 52: 643-7.

51. Christie JD, Kotloff RM, Ahya VN, et al. The effect of primary graft dysfunction on survival after lung transplantation. Am J Respir Crit Care Med 2005; 171(11): 1312-6.

52. Estenne M, Cassart M, Poncelet P, et al. Volume of graft and native lung after single-lung transplantation for emphysema. Am J Respir Crit Care Med 1999; 159(2): 641- 5.

53. Chhajed PN, Malouf MA, Tamm M, et al. Interventional bronchoscopy for the management of airway complications following lung transplantation. Chest 2001; 120(6): 1894-9.

54. Whelan TPM, Hertz MI. Allograft Rejection After Lung Transplantation. Clin Chest Med 2005; 26: 599-612.

55. Iacono AT, Johnson BA, Grgurich WF, Youssef JG, Corcoran TE, Seiler DA, Dauber JH, Smaldone GC, Zeevi A, Yousem SA, Fung JJ, Burckart GJ, McCurry KR, Griffith BP. A randomized trial of inhaled cyclosporine in lungtransplant recipients. N Engl J Med 2006; 354(2): 141-50.

56. PulminiqTM (cyclosporine, USP) Inhalation Solution (CyIS) Briefing Document for the Pulmonary Advisory Committee Meeting June 6, 2005. http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4135B1_02_A-FDAPulminiq.pdf

57. Vincenti F, Kirkman R, Light S. Interleukin-2-receptor blockade with daclizumab to prevent acute rejection in renal transplantation. N Engl J Med 1998; 338: 161-165.

58. Nashan B, Moore R, Amlot P, Schmidt AG, Abeywickrama K, Soulillou J. Randomized trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients. Lancet 1997; 350: 1193-1198.

59. Choi JK, Kearns J, Palevsky HI, et al. Hyperacute rejection of a pulmonary allograft. Immediate clinical and pathologic findings. Am J Respir Crit Care Med 1999; 160: 1015.

60. Van Muylem A, Melot C, Antoine M, et al. Role of pulmonary function in the detection of allograft dysfunction after heart-lung transplantation. Thorax 1997; 52: 643-7.

61. Guilinger RA, Paradis IL, Dauber JH, et al. The importance of bronchoscopy with transbronchial biopsy and bronchoalveolar lavage in the management of lung transplant recipients. Am J Respir Crit Care Med 1995; 152: 2037-43.

62. Yousem SA, Berry GJ, Cagle PT, et al. Revision of the 1990 working formulation for the classification of pulmonary allograft rejection: lung rejection study group. J Heart Lung Transplant 1996; 15: 1-15.

63. Sarahrudi K, Estenne M, Corris P, et al. International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection. J Thorac Cardiovasc Surg 2004; 127: 1126-32.

64. Cahill BC, O’Rourke MK, Strasburg KA, et al. Methotrexate for lung transplant recipients with steroid-resistant acute rejection. J Heart Lung Transplant 1996; 15: 1130-7.

65. Burke CM, Theodore J, Dawkins KD, et al. Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation. Chest 1984; 86: 824- 9.

66. Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 2002; 21: 297-310.

67. Nathan SD, Barnett SD, Wohlrab J, et al. Bronchiolitis obliterans syndrome: utility of the new guidelines in single lung transplant recipients. J Heart Lung Transplant 2003; 22: 427-32.

68. Gerhardt SG, McDyer JF, Girgis RE, et al. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003; 168: 121- 5.

69. Johnson BA, Iacono AT, Zeevi A, et al. Statin use is associated with improved function and survival of lung allografts. Am J Respir Crit Care Med 2003; 167: 1271-8.

70. Hopkins PM, Aboyoun CL, Chhajed PN, et al. Association of minimal rejection in lung transplant recipients with obliterative bronchiolitis. Am J Respir Crit Care Med 2004; 170: 1022-6.

71. Kotloff RM, Ahya VN, Crawford SW. Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation. Am J Respir Crit Care Med 2004; 170: 22-48.