Lung Transplantation

Recipient selection, donor management, outcomes
Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant  2006;25:745-55. Provides disease-specific summaries of indications and contraindications for transplantation, as well as recommendations for timing of referral. http://www.ncbi.nlm.nih.gov/pubmed/16818116?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Hertz MI, Boucek NM, Deng MC, et al. Scientific Registry of the International Society for Heart and Lung Transplantation: introduction to the 2005 annual reports. J Heart Lung Transplant 2005;24:939-44. Provides links to an extensive summary of indications, survival, immunosuppression, morbidity, and mortality for lung transplantation over the past 20 years. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16102426 

Angel LF, Levine DJ, Restrepo MI, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 2006;174:710-6. An educational intervention for the organ procurement organization combined with alveolar recruitment maneuvers, pulmonary toilet, and diuresis increased the lung procurement rate from 11.5% during the 4-year pre-intervention period to 25.5% in the 4 years after protocol implementation.  Donors initially considered poor candidates but subsequently used for transplant had 30-day and 1-year survival comparable to organs initially classified as suitable. http://www.ncbi.nlm.nih.gov/pubmed/16799075?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Rejection
Whelan TPM, Hertz MI. Allograft rejection after lung transplantation. Clin Chest Med 2005;26:599-612.  This review nicely summarizes the pathogenesis, presentation, and management of hyperacute rejection, acute rejection, and bronchiolitis obliterans syndrome. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16263399&query_hl=5

McNeil K, Glanville AR, Wahlers T, et al. Comparison of mycophenolate mofetil and azathioprine for prevention of bronchiolitis obliterans syndrome in de novo lung transplant recipients.  Transplantation  2006; 81:998-1003. There is controversy over whether MMF provides superior protection against rejection compared to azathioprine. This open label multicenter RCT of 315 newly transplanted patients found no differences in the incidence of acute rejection, severity of BOS, time to acquisition of BOS, or survival after 3 years of follow-up.  All patients also received cyclosporine and corticosteroids.  These results may have been affected by the higher proportion of patients withdrawing from azathioprine therapy (59.6% vs. 46.5% in MMF group, p = .02). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16612275&query_hl=27&itool=pubmed_docsum

Gerhardt SG, McDyer JF, Girgis RE, et al. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003; 168:121-5. Interesting pilot found chronic macrolide therapy improved the FEV1 in 5 of 6 patients with bronchiolitis obliterans syndrome.  Subsequently published case series of up to 20 patients also found benefit, but a more definitive study has yet to be published.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12672648

Johnson BA, Iacono AT, Zeevi A, et al. Statin use is associated with improved function and survival of lung allografts. Am J Respir Crit Care Med 2003; 167:1271-8. Although this is a non-randomized, retrospective study, the rigorous analysis, improved outcomes, and the postulated mechanism of benefit for this drug class make the findings provocative. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12615629

Medical complications of lung transplantation
Kotloff RM, Ahya VN. Medical complications of lung transplantation.  Eur Respir J  2004;23:334-42. Nicely summarizes common chronic medical challenges in the lung transplant recipient including infection, malignancy, and renal insufficiency. http://www.ncbi.nlm.nih.gov/pubmed/14979513?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum