Clinics in chest medicine
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Lung transplantation has evolved from an intellectual curiosity to a viable therapeutic option in a selected number of patients with end-stage lung disease. The indications for single lung, double lung, or heart-lung transplantation at major North American transplant centers are presented, the selection criteria are discussed, and the standard preoperative evaluation is outlined. Utilizing these guidelines, a 1-year actuarial survival following each of these procedures of greater than 60% can be expected.
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Clinics in chest medicine · Jun 1990
ReviewInfectious complications in pulmonary allograft recipients.
This article has outlined the features of the major types of infections encountered in pulmonary allograft recipients. Virtually any pathogen can cause infection in these immunocompromised subjects, and there is a distinct propensity for these organisms to invade the transplanted lung. As is the case with other major organ recipients, there is a temporal sequence in the types of infection lung allograft recipients contract. ⋯ Despite these relative successes, however, the risk for infection of the allograft remains high because the defense mechanisms in the lung allograft are breached by the effects of surgery, the "allogeneic environment" in the allograft and systemic immunosuppression, and the fact that chronic rejection causes structural changes that predispose to bacterial colonization of the airways and the need for increased levels of immunosuppression. Despite the formidable barrier that infection of the lung allograft poses, the procedure of pulmonary transplantation clearly holds sufficient promise that all efforts possible should be made to hurdle this barrier. Achieving such a goal would ensure a place for pulmonary transplantation in the armamentarium of treatment for irreversible pulmonary disease.