Lung transplantation: who, when?

Key points

• Lung transplantation is an established therapeutic option for selected patients suffering from end-stage lung diseases, providing survival and quality of life benefits.

• Shortage of donor organs and chronic graft rejection in the form of bronchiolitis obliterans are the two major drawbacks in lung transplantation.

• When to refer to the lung transplant centre is at least as crucial as whom to refer, e.g. patients with idiopathic pulmonary fibrosis have a high mortality on the waiting list and, therefore, this group of patients should be referred early.

• The period of time on the waiting list should be used for active risk management: continuous optimisation of nutrition, comorbidities (e.g. osteoporosis), psychosocial issues and general health behaviour is important, and can be achieved through close collaboration with the lung transplant programme.

Educational aims

• To provide information about the selection of appropriate patients for lung transplantation.

• To outline recommendations for chest physicians concerning who to refer and when.

• To better understand short- and long-term results after the procedure, considering underlying disease, quality of life and survival.

• To present future trends in lung transplant medicine.

Summary Since the first successful lung transplantation was performed in the early 1980s, this procedure has emerged as a mainstay of therapy for patients suffering from end-stage lung diseases. Due to a shortage of donor organs, time on the waiting list is increasing in most transplant programmes and, hence, the timing of referral and listing is crucial. This review discusses the different aspects that should be considered when advising potential lung transplant recipients. Particular focus is given to the appropriate time of referral, matters of medical care whilst on the waiting list, post-transplant prognosis and quality of life issues.