Defying lung transplant current challenges

Lung transplantation has a long, vast, and thrilling history. After a slow start in the second half of the 20^th century, the first human lung transplant was performed just over 60 years ago by Dr. James Hardy (1). The progression of lung transplant was slow due to multitude of reasons, but mainly due to the bad outcomes. These bad outcomes progressively vanished by multiple inventions and better understanding of the immunosuppression and transplant process; these include the cyclosporine protocol success the survival increased from a few days in early lung transplant period to a few years (2). Over the next 20 years, the lung transplant expansion was related to the success of double lung, living donors, and donation with cardiac death (DCD) (3). Another boost was related to establishment of organ donation system along with lung allocation score (LAS) (4,5). Driven by the amelioration of the outcome and the longevity along with the rise of lung transplant support devices such as extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP) and more recently the Organ Care System (OCS). This led to the successful development of DCD followed by the extended criteria which led to more lung transplantation without affecting the survival and the outcomes.

In this special series on lung transplantation, we have assembled an outstanding group of US and international physicians and leading experts in lung transplant field to discuss the current challenges in the field and provide the summit of their expertise of lung transplant from donor and patient selection to best practice in expanding lung transplant to the use of ECMO, EVLP, and OCS. We discussed the ethical aspects of transplant and lung transplant such as the decision about the recipient selection, donation with brain death, these have rarely been discussed before.

Hope in this series you find an excellent and up-to-date information about the current challenges of lung transplant.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Current Challenges in Thoracic Surgery, for the series “Lung Transplant: Current Status and Challenges”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://ccts.amegroups.com/article/view/10.21037/ccts-24-14/coif). The series “Lung Transplant: Current Status and Challenges” was commissioned by the editorial office without any funding or sponsorship. G.M. served as the unpaid Guest Editor of the series and serves as an unpaid Editorial Board Member of Current Challenges in Thoracic Surgery from May 2020 to December 2025. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Hardy JD. Lung homotransplantation in man. JAMA 1963;186:1065-74. [Crossref] [PubMed]
2. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986;314:1140-5. [Crossref] [PubMed]
3. Steen S, Sjöberg T, Pierre L, et al. Transplantation of lungs from a non-heart-beating donor. Lancet 2001;357:825-9. [Crossref] [PubMed]
4. Egan TM, Murray S, Bustami RT, et al. Development of the new lung allocation system in the United States. Am J Transplant 2006;6:1212-27. [Crossref] [PubMed]
5. Maurer JR, Frost AE, Estenne M, et al. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. J Heart Lung Transplant 1998;17:703-9. [PubMed]

George Makdisi