ABSTRACT
The modern era for lung transplantation began in 1981 when Bruce Reitz and colleagues from Stanford University introduced heart-lung transplantation for patients with pulmonary vascular disease.1 Indications for combined heart and lung transplants (HLT) were subsequently widened to include various pulmonary conditions.2 Survival rates were good and in marked contrast with results obtained for single lung transplantation over the preceding 25 years.3 The success of HLT was based on reliable healing of the tracheal anastomosis compared with the bronchial anastomotic breakdown seen frequently following single lung transplantation (SLT). This reliable healing reflected a good blood supply to the proximal donor trachea via donor coronary artery/bronchial artery anastomoses, in contrast to the lack of blood supplied to the proximal donor bronchus following transplantation of a single lung. The lack of success with SLT was also based on both poor selection of potential recipients, some of whom were septic and had multiorgan failure, and the apparently insuperable problems of rejection and infections.
