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In patients undergoing SLT for pulmonary vascular disease, there is dramatic improvement in pulmonary vascular resistance and right ventricular function. Although there is a resultant ventilation-perfusion imbalance, these patients experience a markedly improved functional result. There is no subjective dyspnea or limitation of exercise tolerance related to dead space ventilation of the native lung. However, development of BOS after SLT can lead to severe and precipitous decline in function. Although the data is inconclusive, many believe that BLT provides a longer period of improved functional result in patients with pulmonary vascular disease. Although pulmonary fibrosis represents a minority condition in most lung transplant programs, the functional results of SLT in these patients are excellent. The functional results of BLT for CF are also excellent.

Causes of Death

During the first 30 days after transplantation, graft failure (16.4%) and non-cytomegalovirus infection (24.6%) are the principal fatal complications. After the first year OB is the principal cause of death, contributing to approximately one third of all deaths. Non-cytomegalovirus infections remain a significant cause of late mortality, contributing to approximately 25% and 16% of deaths at 3 and 5 years posttransplant respectively.1,61,62 It is believed that the majority of fatal septic episodes and malignancies such as lymphoma arise as a consequence of the heightened immunosuppression to treat OB. It is therefore quite clear that BOS in lung transplantation is the main factor limiting long-term survival and that a better understanding of the immunologic and molecular mechanisms of this process is one of the main challenges facing clinical lung transplantation today.

References

1. Hertz M, Taylor D, Trulock E et al. The Registry of the International Society for Heart and Lung Transplantation: nineteenth official report. J Heart Lung Transplant 2002; 21:950-970.

2. Maurer JR, Frost AE, Estenne M et al. International guidelines for the selection of lung transplant candidates. J Heart Lung transplant 1998; 17:1703-1706.

3. Zorn G. Lung transplantation in patients with thoracic malignant disease. In: Franco KL, Putnam J, eds. Advanced therapy in Thoracic Surgery. Hamilton, Ontario: BC Decker, 1998.

4. Sundaresan S, Semenkovich J, Ochoa L et al. Successful outcome of lung transplant is not compromised by the use of marginal donor lungs. J Thorac Cardiovasc Surg 1995;109:1075-1079.

5. Ware LB, Wang Y, Fang X et al. Assessment of lungs rejected for transplantation and implications for donor selection. Lancet 2002; 360:619-620.

6. Fiser SM, Kron IL, McLendon LS et al. Early intervention after severe oxygenation elevation improves survival following lung transplantation. J Heart Lung Transplant 2001; 20:631-636.

7. Bhorade SM, Vigneswaran W, McCabe MA et al. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000; 19:1199-1204.

8. Gabbay E, Williams TJ, Griffiths AP et al. Maximizing the utilization of donor organs offered for lung transplantation. Am J Resp Crit Care Med 1999; 160:265-271.

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