Christopher A. Bracken

Lung transplantation: Historical perspective, current concepts, and anesthetic considerations

E ND-STAGE LUNG disease (ESLD) is a major cause of death in western civilization. In 1985, chronic obstructive pulmonary disease (COPD), with more than 75,000 deaths, was the fifth leading cause of death in the United States. Idiopathic pulmonary fibrosis is another form of ESLD that has a high mortality, and once the diagnosis is made, the 5-year mortality varies from 40% to 80%. c~-1-Antitrypsin deficiency is found in approximately one of every 1,500 to 5,000 live births and accounts for approximately 40,000 patients in the United States. Cystic fibrosis (CF), another congenital disease, occurs in one of every 2,000 live births. There is currently very little that medicine can offer these patients. For many, lung transplantation is the only hope for survival, let alone recovery of independent function. Lung transplantation, actually a family of operations, includes single-lobe transplantation in the pediatric patient, single-lung transplantation (SLTx), double-lung (DLTx) with carina (en bloc), bilateral sequential single-lung (BSSLTx), and heart-lung block transplantation (HLTx). Various operations are proposed for different patient conditions, and some are more widely accepted than others. Bolton and Weiman I have attempted to describe precise physiological mechanisms of lung function elicited by different thoracic incisions and parenchyma resections to more scientifically choose appropriate transplantation operations. By far, most lung transplantations are SLTx or BSSLTx. Heart-lung transplantations and en bloc double-lung transplantations are now being performed less frequently than in the past.