Bonus Material-20_2025 Dlevine transplant board review

Pdf Summary

This comprehensive review on Lung Transplantation (LT), presented by Dr. Deborah Jo Levine, covers historical progress, current practices, indications, complications, and future directions as of 2025.<br /><br />Lung transplantation is an established treatment for advanced, life-threatening lung diseases, with over 69,000 adult lung transplants performed worldwide from 1992 to 2023. Primary indications include conditions like cystic fibrosis, COPD, idiopathic pulmonary fibrosis (IPF), and obliterative bronchiolitis. Heart-lung transplants are reserved for patients with combined irreversible cardiac and pulmonary disease.<br /><br />Survival after lung transplant has improved across eras but remains challenged by complications such as chronic lung allograft dysfunction (CLAD), the leading cause of death beyond the first year post-transplant. CLAD is an irreversible decline in lung function with phenotypes including bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Risk factors include acute cellular rejection (ACR), antibody-mediated rejection (AMR), donor-specific antibodies (DSA), infections, and gastroesophageal reflux.<br /><br />Rejection types discussed include hyperacute, acute cellular, antibody-mediated, and chronic (CLAD). ACR, the most common early rejection, is diagnosed by histopathology and treated primarily with corticosteroids. AMR diagnosis and treatment remain evolving, involving graft dysfunction assessment, antibody profiling, and pathology evaluation.<br /><br />Post-transplant infections, especially bacterial (e.g., Pseudomonas), viral (notably CMV), and fungal infections, significantly influence outcomes. Prophylaxis and vigilant monitoring are crucial.<br /><br />Medication regimens include immunosuppressants—calcineurin inhibitors (tacrolimus, cyclosporine), corticosteroids, and anti-metabolites—with attention to drug interactions impacting drug levels and toxicity. Side effects leading to comorbidities like renal dysfunction, cytopenias, diabetes, and hypertension are common.<br /><br />The organ allocation in the U.S. transitioned to the Lung Composite Allocation Score (CAS) in 2023, prioritizing recipients based on urgency and expected outcomes. Novel strategies to improve donor lung availability include ex vivo lung perfusion (EVLP) and utilizing donation after circulatory death (DCD) lungs.<br /><br />In summary, LT has advanced considerably since its inception in 1963 but still faces challenges related to rejection, infection, and medication management. Ongoing research aims to enhance donor lung quality, immunosuppression balance, and overall patient survival.

Meta Tag

Concept Lung Transplantation

Concept Acute Cellular Rejection

Concept Chronic Lung Allograft Dysfunction

Concept Rejection

Concept Candidate Selection

Keywords

lung transplantation

chronic lung allograft dysfunction

acute cellular rejection

antibody-mediated rejection

cystic fibrosis

CF

COPD

Chronic Obstructive Pulmonary Disease

idiopathic pulmonary fibrosis

immunosuppressants

ex vivo lung perfusion

lung allocation score

Lung Transplantation

Acute Cellular Rejection

Chronic Lung Allograft Dysfunction

Rejection

Candidate Selection