Lung Transplantation: Evolving Concepts and Controversies

In the past 40 years, lung transplantation has moved from an experimental procedure performed in only a few patients to an effective treatment that has improved the quality of life and survival of countless patients with advanced lung disease. Lung transplantation is now a viable therapeutic option in the care of patients with emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis, and pulmonary hypertension. However, despite significant progress in the field of lung transplantation, much remains to be learned regarding the appropriate selection of candidates, prevention of early graft dysfunction, and optimal long-term management. Lung recipients are particularly vulnerable to the development of infections and to chronic lung dysfunction manifest as bronchiolitis obliterans syndrome (BOS). This issue of Seminars in Respiratory and Critical Care Medicine devoted to lung transplantation incorporates clinical and basic knowledge to provide a comprehensive perspective on the science and practice of human lung transplantation.

In this issue, Dr. Lynch and colleagues provide an excellent overview of the field of lung transplantation and identify disease-specific criteria for the selection of lung transplant recipients. Drs. Meyer and Bhorade provide a comprehensive overview of modern immunosuppression and its application to lung transplantation. Dr. Glanville provides an excellent analysis of the role for bronchoscopy and other surveillance monitoring in the care of lung transplant recipients. Drs. Studer and Orens describe the critical factors that determine the suitability of a potential donor lung and also highlight areas of controversy in donor selection. Drs. Carter and Davis provide an excellent description of the current surgical approaches to manage and prevent early primary allograft dysfunction.

The remainder of the issue focuses on longer-term complications after lung transplantation. Drs. Arcasoy and Wilt provide a comprehensive discussion of posttransplant medical complications, whereas Drs. Knoop and Estenne consider the diagnosis and management of pulmonary allograft rejection. Dr. Snyder and I highlight recent advances in our understanding of the immune mechanisms of lung rejection. Dr. Avery provides a comprehensive overview of infectious complications after lung transplantation. Drs. Wells and Faro provide an outstanding summary of the special considerations that apply to pediatric lung transplant recipients. Finally, Drs. Hadjiliadis and Angel consider the controversial medical and ethical issues surrounding the choice of single versus bilateral lung transplantation.

Collectively, these authors have created a wonderful contribution to the field of lung transplantation. We thank all the contributors for their hard work and scholarly contributions. Reading through each article it is clear that, although we have made much progress in the application of lung transplantation to patients with advanced lung disease, the future holds even greater promise as we advance our understanding of basic pulmonary immunology, patient selection, and immunosuppressive medications.