Current Status of Lung Transplantation

Lung transplantation has come of age with the development of a critical mass of experienced clinicians who are committed to pooling their knowledge to solve the clinical problems that continue to confound the benefits individual patients may enjoy from these life-saving procedures. Adequately powered clinical trials are in progress to assist decision making regarding the role of newer immunosuppressive agents. Therapeutic drug monitoring has become critical to minimizing preventable complications such as renal dysfunction with calcineurin inhibitors. Fibroproliferation inhibitors are used more widely to ameliorate the abnormal healing response to allodependent or alloindependent injury, the latter perhaps related to underrecognized gastroesophageal reflux disease for which fundoplication is now proposed as an effective preventative measure. Cumulative damage to the graft from low-grade rejection is now appreciated as a potential cause of graft loss perhaps via an insidious small vessel vasculitis causing bronchiolar ischemic injury. Clearly, despite some progress, substantive challenges remain.