الفهرس 
ANATOMY OF RESPIRATORY SYSTEMOnly 14 pages are availabe for public view
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Abstract
L
ung transplantation is emerged as life saving procedure for patients with end stage pulmonary disease. The procedure has evolved over the past 44 years with changes in the surgical techniques and immuno-suppressive regimens as the introduction of cyclosporin A in 1980s.
The most common indication for lung transplantation is chronic obstructive pulmonary disease followed by idiopathic pulmonary fibrosis, cystic fibrosis which considered third most common indication and pulmonary arterial hypertension.
Reported cumulative world experience exceeds 13.000 lung transplants with 76.4% 1- year and 42.6% 5-year overall survival. Patients with PAH,idiopathic pulmonary fibrosis, and sacroidosis have higher early mortality rates than those with other diagnoses. Patients with cystic fibrosis have 1-, 5-, and 10 year survival rates of 78%, 52%, and 37% while those recipients with PAH have survival rates of 64%, 44%, and 20%, respectively. As noted, patients with PAH have the highest early hazard of all diagnoses. This can be explained by the complexity of the operation, the requirement for cardiopulmonary bypass, and the right ventricular dysfunction common in these patients. Lastly 5 years survival rates is 42% for COPD and 36% for pulmonary fibrosis.
The two most common causes of death after the first transplant year include bronchiolitis obliterans and infection. Long-term success of lung transplantation is limited by chronic allograft dysfunction, thought to be primarily due to chronic allograft rejection. This injury has been characterized by scar formation and fibrosis of the small airways and is defined as bronchiolitis obliterans. The diagnosis of bronchiolitis obliterans requies a histopathologic specimen that includes the small to medium sized airways. However, transbronchial biopsy specimens are insensitive for this diagnosis, since mostly alveolar tissue is obtained and bronchioles are infrequently sampled. The international society for Heart and Lung ransplantation developed a reproducible and reliable surrogate marker for bronchiolitis obliterans that utilizes declining FEV1.
Bronchiolitis obliterans syndrome (BOS) is the most common cause of morbidity and mortality following lung transplantation. AT 5 years. 50% of transplanted patients have developed BOS and of the survivors, more than 33% continue to carry this diagnosis. Quality of life is significantly reduced once BOS develops, and the risk for death due to infection may also be increased.
Five years after transplantation, the most common morbidities excluding bronchiolitis obliterans include hypertension, hyperlipidema, renal dysfunction, and diabetes. Osteoporosis can be prevented to some extent. All are a consequence of immunosppressive therapy.
Despite all of these factors, more than 80% of 1, 3-, and 5- year survivors reported no activity limitations on follow-up. In addition, at 5 years, 40% of patients reported they were working full or part time.