Lung transplantation: state of the art and current practice

This article is a reflection of the present status of lung transplantation in the UK and worldwide and its transformation of end-stage lung disease. In its infancy, it was swept along by the determination and drive of surgical pioneers. Amongst them the names Demikhov, Hardy, Schumway, Cooley, Reitz, Cooper and Patterson have exemplified the surgeons' drive to bring lung transplantation to clinical fruition. With long-term survivors of heart-lung transplantation (HLTx) from 1981, single lung transplantation (SLT) from 1983 and bilateral lung transplantation (BLTx) from 1986, this decade saw the true genesis of clinical lung transplant programmes. In the modern era, research into donor organ regeneration with ex vivo lung perfusion (EVLP) and retrieval of lungs from non-brain dead donors (DCD transplantation), drug improvements in immunosuppression, technique improvements with ECMO and off-pump surgery have constantly pushed the boundaries and consistently seen a rise in lung transplantation year on year and it now exceeds cardiac transplant activity despite falling numbers of organ donors.