immunology allergic disorders
Lung and Heart Lung Transplantation
Introduction
Lung or heart-lung transplantation is an option for patients who have respiratory insufficiency or failure and who remain at risk of death despite optimal medical treatment. (See also Overview of Transplantation ) Themost common indications for lung transplantationare Chronic Obstructive Pulmonary Disease (COPD) None Idiopathic Pulmonary Fibrosis None Cystic Fibrosis None Alpha-1 Antitrypsin Deficiency None Primary Pulmonary Hypertension None include other interstitial lung disorders (eg, Sarcoidosis ), Single and double lung procedures are equally appropriate for most lung disorders without cardiac involvement; the exception is chronic diffuse infection (eg, bronchiectasis), for which double lung transplantation is best. Indications for heart-lung transplantationare Eisenmenger Syndrome None Any lung disorder with severe ventricular dysfunction likely to be irreversible Cor pulmonale often reverses after lung transplantation alone and is therefore rarely an indication for heart-lung transplantation. Relative contraindicationsinclude Age (single lung recipients must be<65; double lung recipients,<60; and heart-lung recipients,<55) Current cigarette smoking Previous thoracic surgery For some cystic fibrosis patients and at some medical centers, lung infection with resistant strains ofBurkholderia cepacia, which greatly increases mortality risk Single and double lung procedures are about equally common and are at least 8 times more common than heart-lung transplantation. 