Clinics in chest medicine
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Lung allocation in the United States has changed significantly with the introduction of the Lung Allocation Score (LAS) system in May 2005. Since then, organ allocation is no longer based on waiting time but on a measure of transplant benefit (the difference between survival with vs without a transplant). The LAS system has met its primary goal of reducing time and mortality on the waiting list. Better understanding of pretransplant factors that influence long-term posttransplant outcomes of the individual patient will be instrumental in improving the LAS system in the future.
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Clinics in chest medicine · Jun 2011
ReviewAlternatives to lung transplantation: treatment of pulmonary arterial hypertension.
The development of targeted therapies for pulmonary arterial hypertension currently based on prostaglandin, nitric oxide, and endothelin pathways has resulted in major advances in the treatment of patients with pulmonary arterial hypertension. This article reviews the current evidence that supports both the use of mono- and combination therapy. The article also considers the role of atrial septostomy in the treatment of pulmonary arterial hypertension, particularly as a bridge to transplantation. Finally, the article provides a review of the role and outcomes of pulmonary thromboendartertectomy for patients with chronic thromboembolic pulmonary hypertension.
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This article reviews recent developments in the selection, assessment, and management of the potential lung donor that aim to increase donor organ use. The scarcity of suitable donor organs results in long waiting times and significant mortality for those patients awaiting transplant. Strategies to expand the donor pool can substantially improve donor lung use rates. Although further long-term studies are required to confirm that long-term outcomes are not being compromised, the available evidence suggests that the traditional factors defining a lung as marginal or extended do not actually compromise outcomes within the framework of current donor management strategies.
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Immunosuppressive therapy has contributed significantly to improved survival after solid organ transplantation. Nevertheless, treatment-related adverse events and persistently high risk of chronic graft rejection remain major obstacles to long-term survival after lung transplantation. The development of new agents, refinements in techniques to monitor immunosuppression, and enhanced understanding of transplant immunobiology are essential for further improvements in outcome. In this article, conventional immunosuppressive regimens, novel approaches to preventing graft rejection, and investigational agents for solid organ transplantation are reviewed.
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There are 6 major types of airway complications following lung transplantation: necrosis and dehiscence, infection, granulation tissue formation, malacia, fistulae, and stenosis. This article reviews the risk factors for developing airway complications after lung transplantation, the clinical features of the complications, and treatment options for these problems.