The evolution of lung transplantation: A clinical update
Lung transplantation has become an effective treatment for patients with end-stage pulmonary disease. Despite several decades of experience, however, lung transplantation continues to be associated with significant morbidity and mortality. Even with the implementation of improved surgical techniques, 5-year survival according to the International Society for Heart and Lung Transplantation remains a somewhat disappointing 45%. Non-cytomegalovirus-associated infections and primary graft failure account for the majority of short-term mortality, whereas bronchiolitis obliterans syndrome continues to be the leading cause of death over longer periods. Concurrently, the mortality rate of potential lung transplant recipients while on the waiting list consistently remains approximately 10% to 15% annually because of the severe shortage of suitable organs. Recent trends suggest that short-term survival rates are improving, perhaps in part because of several strategies that appear to decrease ischemia-reperfusion injury. Furthermore, several promising approaches have been developed or are currently under investigation, which may help to improve long-term survival rates of lung transplant recipients and expand the donor pool. © 2004 Elsevier Inc. All rights reserved.
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