Respiratory care clinics of North America
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyCurrent concepts and controversies in lung transplantation.
This article reviews the history of organ transplantation, specifically focusing on the advances leading to the first successful human lung transplant. It also provides an overview of the com-mon indications and general selection criteria for lung transplant recipients, highlights areas of current controversy in pulmonary transplantation, reviews current approaches to posttransplantation immunosuppression, and discusses common complications seen intransplant recipients.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudySurgical considerations in lung transplantation: transplant operation and early postoperative management.
During the last 20 years improvements in perioperative care have led to improved outcomes for lung transplant recipients. Although uncommon, technical complications can be the source of significant morbidity and mortality. Infections and ischemia-reperfusion injury continue to have the greatest impact on short-term outcomes of lung transplant recipients, and research into the prevention and treatment of these two entities will be necessary to improve these patients' outcomes significantly.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyCost-effectiveness and quality of life: benefits of lung transplantation.
Improvement in quality of life is a major reason patients choose to undergo lung transplantation. This article reviews the present state of knowledge regarding the effects of lung transplantation on health-related quality of life (HRQL), and the cost-effectiveness of lung transplantation. ⋯ Studies of cost effectiveness are few in number, and cost-effectiveness estimates vary widely. More data regarding the HRQL benefits of lung transplantation will allow these concepts to be used in lung transplantation decision-making.
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A constant awareness of the risk to the living donors must be maintained with any live-donor organ transplantation program, and comprehensive short- and long-term follow-up should be strongly encouraged to maintain the viability of these potentially life-saving programs. There has been no perioperative or long-term mortality following lobectomy for living lobar lung transplantation, and in the authors' series the perioperative risks associated with donor lobectomy are similar to those seen with standard lung resection. These risks might increase if the procedure were offered on an occasional basis and not within a well-established program. ⋯ Although cadaveric transplantation is preferable because of the risk to the donors, living lobar lung transplantation should continue to be used under properly selected circumstances. Although there have been no deaths in the donor cohort, a risk of death between 0.5% and 1% should be quoted pending further data. These encouraging results are important if this procedure is to be considered as an option at more pulmonary transplant centers in view of the institutional, regional, and intra- and international differences in the philosophical and ethical acceptance of the use of organs from live donors for transplantation.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyThe role of bronchoscopy in the management of lung transplant recipients.
Bronchoscopy is an integral piece in the complex multidisciplinary approach to the care of lung transplant recipients. Although the use of surveillance bronchoscopies is controversial, bronchoscopy undoubtedly provides valuable information in patients with respiratory symptoms or functional decline. ⋯ The objectives of the research should be to increase the yield of bronchoscopy, improve its safety, and decrease procedure-related discomfort. Only randomized, multicenter clinical trials with full commitment from lung transplant centers can accomplish these goals.