Overview
How common are lung transplantations?
What is the cost effectiveness of lung transplantation?
What is living donor lung transplantation?
What is the evolution of lung transplantation procedures?
What are the indications for lung transplantation?
Which factors determine the appropriate timing for referral to a lung transplant program?
What is the BODE index to assess the need for lung transplantation in patients with COPD?
What are the ISHLT criteria for referral and listing for lung transplantation in patients with COPD?
What are the ISHLT absolute contraindications for lung transplantation?
Which extrapulmonary organ dysfunctions are absolute contraindications for lung transplantation?
What are the relative contraindications for lung transplantation?
Why is age a relative contraindication for lung transplantation?
Is atherosclerotic disease a contraindication for lung transplantation?
Which infections are relative contraindications for lung transplantation?
Why is ventilator dependence a relative contraindication for lung transplantation?
Which psychosocial issues are relative contraindications for lung transplantation?
Why are corticosteroids a relative contraindication for lung transplantation?
What are the contraindications for lung transplantation in patients with cystic fibrosis?
When is body weight a relative contraindication for lung transplantation?
Which comorbidities are relative contraindications for lung transplantation?
What are the reported outcomes following lung transplantation?
Workup
What is the role of lab tests in the pretransplant workup for lung transplantation?
What is included in the pretransplant workup for lung transplantation?
Treatment
Which transplant center features are associated with better lung transplantation outcomes?
What are the donor selection criteria for lung transplantation?
What is the waiting time for lung transplantation recipients?
When is heart-lung transplantation indicated?
When is double-lung transplantation indicated?
When is single-lung transplantation indicated?
Which factors affect the selection of lung transplantation procedure?
What is included in the preoperative evaluation of lung transplantation donors?
How are donor lungs managed prior to transplantation?
What are the criteria for brain death in a lung donor?
How are donor lungs preserved prior to transplantation?
How are patients monitored during lung transplantation?
How are single-lung transplantations performed?
How are donor lungs harvested for transplantation?
How are double-lung transplantations performed?
How are heart-lung transplantations performed?
Why is the postoperative period crucial in determining lung transplantation success?
What is included in postoperative respiratory management following lung transplantation?
What are the postoperative hemodynamics following lung transplantation?
What are the possible postoperative GI complications following lung transplantation?
What causes postoperative renal complications following lung transplantation?
What is included in postoperative fluid management following lung transplantation?
What is the role of antimicrobial therapy following lung transplantation?
How is nutrition maintained following lung transplantation?
What are the possible surgical complications from lung transplantation?
How are patients monitored in the immediate postoperative period following lung transplantation?
How are patients monitored in the early postoperative period following lung transplantation?
How are patients monitored in the late postoperative period following lung transplantation?
What is the role of immunosuppression in lung transplantation protocols?
What is the role of tacrolimus in lung transplantation?
What is the role of mycophenolate mofetil (MMF) in lung transplantation?
What is the role of cyclosporine in lung transplantation?
What is the role of azathioprine in lung transplantation?
What is the role of rapamycin in lung transplantation?
What is the role of corticosteroids in lung transplantation?
What is the role of antilymphocyte antibody preparations in lung transplantation?
What is the role of induction therapy in lung transplantation?
What is included in immunotherapy maintenance following lung transplantation?
What is reimplantation response following lung transplantation?
What is graft dysfunction following lung transplantation?
What is hyperacute AMR rejection following lung transplantation?
What causes hyperacute rejection of a lung transplant?
What is acute AMR rejection following lung transplantation?
How is rejection categorized following lung transplantation?
What causes acute rejection of a lung transplant and how is it managed?
What causes bronchiolitis obliterans syndrome (chronic rejection) following lung transplantation?
What are the possible airway complications of lung transplantation?
What are the possible vascular complications of lung transplantation?
What are the possible renal complications of lung transplantation?
Which infections may complicate a lung transplantation?
What is the increased risk for cancer following lung transplantation?
Guidelines
What are the ISHLT guidelines on selection of lung transplantation candidates with COPD?
What are the ISHLT guidelines on selection of lung transplantation candidates with cystic fibrosis?
What are the ISHLT guidelines on selection of lung transplantation candidates with COPD?
What are the ISHLT guidelines on antibody-mediated rejection (AMR) of lung transplantation?
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This chest radiograph performed 24 hours following right unilateral lung transplantation is within normal limits.
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Seventy-two hours following lung transplantation, this patient developed dyspnea and hypoxemia. The bronchoscopy and bronchoalveolar lavage revealed no evidence of bacterial infection. The likely cause of this deterioration is reperfusion/reimplantation response.
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A 19-year-old woman had living donor transplantation. She developed pulmonary artery stenosis several months later. This was treated with a pulmonary artery stent. Courtesy of A. Szabo, RN.
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This patient developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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Lateral chest radiograph on a patient who developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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The CT scan of the chest of a patient with confirmed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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A 34-year-old man developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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Lateral radiograph of a 34-year-old man who developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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The high-resolution CT scan showing findings of branchio-otorenal (BOR) syndrome following bilateral lung transplantation (BLT).
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Bronchopleural fistula following right pneumonectomy and left single-lung transplantation (SLT).
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Severe acute rejection within 10 days of lung transplantation (lower magnification). The typical histological findings are perivascular lymphocytic infiltrates. Courtesy of Zhaolin Xu, MD.
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Severe acute rejection within 10 days of lung transplantation (high power). Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the low-power field, which is indicating acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the high-power field, which indicates acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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Bronchial anastomosis. Posterior wall closure is performed with a continuous suture.
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Right atrial anastomosis. Continuous anastomosis with the common pulmonary vein joined to the atrium.
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Completed atrial anastomosis.
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Donor lung showing hilar surface.
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The clamps are exposing the donor vein.
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Donor bronchus, artery to the right and vein to the left.
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Right donor bronchus.
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A close-up shot of the donor vein.
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Bilateral lung transplantation to treat cystic fibrosis in a 23-year-old woman. Anteroposterior (AP) chest radiograph shows mild edema in the right perihilar region soon after surgery; this finding is consistent with an implantation response.
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Anteroposterior (AP) chest radiograph obtained the following day shows increased edema.
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Bilateral lung transplants in 23-year-old woman who developed infection at the bronchial anastomoses. CT scan shows right bronchial stenosis (arrow).
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CT image shows left bronchial stenosis (arrow).
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Posteroanterior (PA) chest radiograph in a 23-year-old woman who underwent bilateral lung transplantation because of cystic fibrosis. Image shows left upper-lobe collapse. Bilateral bronchial stents are in place.
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Lateral radiograph shows left upper-lobe collapse. Arrow points to a bronchial stent. Bronchoscopy showed that scar tissue obliterated the orifice to the left upper-lobe bronchus.
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CT image in a 61-year-old-woman with a single-lung transplant for emphysema with Aspergillus infection. Image shows an ill-defined nodule in the right upper lobe with a surrounding halo of ground-glass opacity (arrow), a finding virtually diagnostic of Aspergillus infection in the correct clinical setting.
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Aspergillus infection 61-year-old man with a left lung transplant because of idiopathic pulmonary fibrosis. Frontal chest radiograph shows a normal left (transplant) lung and lower-lobe consolidation in the right (native) lung.
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CT of patient shows patchy areas of consolidation in the right lower lobe and a clear left lung. Biopsy showed Aspergillus infection.
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Cytomegaloviral (CMV) infection in a 52-year-old man with a right lung transplant because of emphysema. Frontal chest radiograph shows right lower-lobe and left mid-lung consolidation and a small right pleural effusion. Note that the less-compliant transplant lung pulls the mediastinum to the right.
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CT of patient with cytomegaloviral (CMV) pneumonia shows patchy consolidation, greater on the right (transplant lung) than on the left, and a right pleural effusion.
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Chest radiograph in bilateral lung transplant recipient showing bilateral pneumothoraces (arrows).
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CT shows pneumothorax in common pleural space (arrow).
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Lung carcinoma in lung transplant recipient. PA chest radiograph shows a spiculated nodule in the lower lobe of the native right lung.
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Primary lung carcinoma in lung transplant recipient. CT scan of patient with previous radiograph shows spiculated nodule in the lower lobe of the emphysematous native right lung (arrow).
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Post-transplant lymphoproliferative disorder in double lung transplant recipient. Contrast-enhanced CT scan shows low attenuation mass (arrow) in the anterior mediastinum.
