ABSTRACT
James Hardy performed the first lung transplantation (LT) in a human in 1963. Indications for LT include any chronic end-stage pulmonary disease, refractory to maximal medical therapy or for which no medical therapy exists. Currently, chronic obstructive pulmonary disease (COPD) is the leading indication for LT, followed by idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), emphysema due to alpha-1 antitrypsin deficiency, and idiopathic pulmonary arterial hypertension (IPAH). The donor chest is opened by median sternotomy, extending the incision inferiorly to the pubis, to permit extraction of the abdominal organs. Thymic remnants are dissected until the innominate vein is identified. Recently, new strategies have been developed to potentially increase the lung donor pool, such as the use of lungs from donors after circulatory death-donation after circulatory death (DCD), and the use of ex vivo lung perfusion (EVLP). Patients with septic lung disease require a double lung transplantation (DLT) to remove the entire focus of sepsis.
