Friday, August 25, 2006

Overview of Lung Transplantation

Medscape Transplantation has published this excellent overview of lung transplantation. Go the the web site for the full article with references.

Overview of Lung Transplantation
For many patients with end-stage lung disease, lung transplant is the only option available, and it offers the chance for their quality of life to be significantly improved. In the adult, the vast majority of lung transplants are performed for 4 conditions: chronic obstructive pulmonary disease (COPD) (39%), idiopathic pulmonary fibrosis (17%), cystic fibrosis (16%), and alpha-1-antitrypsin deficiency (9%). Whenever possible, bilateral lung transplants are preferred; however, in cases of pulmonary fibrosis and selected cases of emphysema, single-lung transplants are acceptable and help to distribute needed organs to a larger population of critically ill patients. Because of the risk of infection and cross-contamination, unilateral lung transplants are contraindicated in patients with cystic fibrosis and bronchiectasis. Overall, an equal number of single- and double-lung transplants have been performed annually since 1995.

The benefit of lung transplantation comes in the form of both survival and quality of life. However, the benefit is not realized until 3 to 6 months following transplant and comes with up-front risk. Even in experienced transplant programs, operative mortality rates may be as high as 8% and 3month survival is approximately 84%. From 1992 to 2003, overall survival at 1, 3, 5, and 10 years was 74%, 58%, 47%, and 24%, respectively, with the average life expectancy following transplant just more than 3 years. In general, patients with COPD, emphysema, and cystic fibrosis fare better than those who received transplants for other conditions.

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