Surgery: Transplantation

Lung transplantation has emerged over the past 20 years as a successful treatment option for a variety of end-stage lung diseases. The first human lung transplantation procedure was performed in 1963, but a limited number of procedures were carried out over the next 20 years because of poor outcomes. During this time period, the main complication was impaired bronchial anastomotic healing, and dehiscence was a common cause of death after the first postoperative week. In the early 1980s, when surgical techniques were refined and ciclosporin first became available, lung transplantation became a viable treatment option for carefully selected recipients suffering from a variety of end-stage lung diseases. Since then, activity has grown rapidly and, currently, approximately 1600 lung transplant procedures are performed annually worldwide. However, long-term results remain disappointing, and the 5-year survival rate is approximately 45%. Chronic rejection is the leading cause of death after the first year, and common complications including infections, hypertension, renal insufficiency, and diabetes mellitus that significantly impact the recipient's quality of life. Nonetheless, in appropriately selected recipients, transplantation prolongs survival and improves quality of life.