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Current opinion in organ transplantation: lung transplantation.

DOI:10.1097/MOT.0000000000000644 Lung transplantation (LTx) is now in its 4th decade and worldwide, over 5000 procedures are performed each year, predominantly bilateral sequential single LTx although single LTx is preferred by some units for specific indications, especially in older recipients. Heart-LTx is now reserved almost exclusively for complex congenital heart disease with severe pulmonary hypertension where the cardiac defect is refractory to operative repair. Rarely, combined procedures are indicated such as combined bilateral lung and liver transplantation particularly for patients with cystic fibrosis who have both bronchiectasis-associated respiratory failure and cirrhosis. Outcomes for LTx have lagged somewhat behind other forms of solid organ transplantation (SOT), perhaps reflecting the exposure of the transplanted organ to the external environment with every breath including exposure to toxic substances in ambient air pollution and a myriad of respiratory tract infections such as community acquired respiratory viruses (CARV). In common with other SOT practices, selecting appropriate recipients at the right time and matching them with viable donor organs is critical. Much progress has been made in the field to improve access to organ donation with the recognition that donation after circulatory death is not associated with inferior outcomes when compared with donation after brain death and that ex-vivo lung perfusion and ventilation may enable the rehabilitation and subsequent utilization of organs that were previously deemed not safe to transplant. These areas are well discussed by Ceulemans, Inci and Van Raemdonck (pp. 288– 296) and Ali and Cypel (pp. 297–304) who detail recent exciting developments at the cutting edge of lung organ donor management. These advances and those in many other areas of LTx are all predicated on translational science and now there is an expanding body of researchers working in the field to solve some of the issues which beset the LTx recipient. These include the sometimes subtle causes of allograft loss such as antibody mediated rejection, the ever present risk of allograft infection, especially with CARV as detailed by Jens Gottlieb (pp. 311– 317) and the rapidly expanding knowledge base