ABSTRACT
Inclusion of a chapter on pulmonary transplantation in a textbook devoted to the manage ment of pulmonary disease is appropriate, since this form of therapy for end-stage cardio pulmonary disease is now widely accepted by health care providers and third-party payers. Such acceptance is a relatively recent development. The field of pulmonary transplantation did not achieve such a status until the beginning of the last decade of the twentieth century, years after the acceptance of renal, hepatic, and cardiac transplantation. The clinical chal lenges leading to the late blossoming of pulmonary transplantation will become apparent to the reader as the chapter unfolds. Advances in recipient selection, organ preservation, operative technique, and immunosuppression have markedly improved the early survival of lung recipients. Approximately 75% of lung recipients worldwide will survive at least 1 year; 5-year survival, however, is just reaching 50% and lags well behind that for other solid organs, which approaches 75%. The principal cause for late mortality following lung transplantation is the bronchiolitis obliterans syndrome, which is believed to be a manifestation of chronic rejection of the lung allograft. Much effort is being devoted to understanding the pathogenesis of chronic rejection and to developing strategies for its pre vention and management. As these efforts begin to bear fruit, it is likely that survival fol lowing lung transplantation will equal that of other major solid organs, firmly establishing this technique as a treatment for patients who have failed conventional medical therapy.
