Respiratory care clinics of North America
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The current availability of lung donors is far exceeded by the number of potential transplant recipients who are waiting for an organ. This disparity results in significant morbidity and mortality for those on the waiting list. Although it is desirable to increase overall consent rates for organ donation, doing so requires an intervention to affect societal response. ⋯ Transplantation of organs from marginal or extended-criteria donors may result in some increase in complications or mortality, but this possibility must be weighed against the morbidity and risk of death risk faced by individuals on the waiting list. The effects of this trade-off are currently being studied in kidney transplantation, and perhaps in the near future lung transplantation may benefit from a similar analysis. Until that time, the limited data regarding criteria for donor acceptability must be incorporated into practice to maximize the overall benefits of lung transplantation.
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A constant awareness of the risk to the living donors must be maintained with any live-donor organ transplantation program, and comprehensive short- and long-term follow-up should be strongly encouraged to maintain the viability of these potentially life-saving programs. There has been no perioperative or long-term mortality following lobectomy for living lobar lung transplantation, and in the authors' series the perioperative risks associated with donor lobectomy are similar to those seen with standard lung resection. These risks might increase if the procedure were offered on an occasional basis and not within a well-established program. ⋯ Although cadaveric transplantation is preferable because of the risk to the donors, living lobar lung transplantation should continue to be used under properly selected circumstances. Although there have been no deaths in the donor cohort, a risk of death between 0.5% and 1% should be quoted pending further data. These encouraging results are important if this procedure is to be considered as an option at more pulmonary transplant centers in view of the institutional, regional, and intra- and international differences in the philosophical and ethical acceptance of the use of organs from live donors for transplantation.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyCost-effectiveness and quality of life: benefits of lung transplantation.
Improvement in quality of life is a major reason patients choose to undergo lung transplantation. This article reviews the present state of knowledge regarding the effects of lung transplantation on health-related quality of life (HRQL), and the cost-effectiveness of lung transplantation. ⋯ Studies of cost effectiveness are few in number, and cost-effectiveness estimates vary widely. More data regarding the HRQL benefits of lung transplantation will allow these concepts to be used in lung transplantation decision-making.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyCurrent concepts and controversies in lung transplantation.
This article reviews the history of organ transplantation, specifically focusing on the advances leading to the first successful human lung transplant. It also provides an overview of the com-mon indications and general selection criteria for lung transplant recipients, highlights areas of current controversy in pulmonary transplantation, reviews current approaches to posttransplantation immunosuppression, and discusses common complications seen intransplant recipients.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyMedical complications and management of lung transplant recipients.
Lung transplantation is associated with a great number of major medical complications that act in concert to limit the long-term success of this difficult treatment option for advanced lung disease. Close and parallel attention to pulmonary and nonpulmonary medical complications and management of lung transplant recipients by a multidisciplinary team are the most important ingredients of optimal long-term outcomes.