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Heart-Lung Transplantation

Background

Heart-lung transplantation (cardiopulmonary transplantation) is the simultaneous surgical replacement of the heart and lungs in patients with end-stage cardiac and pulmonary disease.
This procedure remains a viable therapeutic alternative for patients in specific disease states, though the frequency of application has substantially diminished in recent years.

Causes of end-stage cardiopulmonary failure that necessitate cardiopulmonary transplantation range from congenital cardiac disease to idiopathic causes and include the following:

Irreparable congenital cardiac anomalies with pulmonary hypertension (Eisenmenger complex)

Primary pulmonary hypertension with irreversible right-heart failure

Sarcoidosis involving only the heart and lungs

Early clinical applications of heart-lung transplantation met with poor results secondary to poor patient selection, inexperience with preservation methods, insufficient understanding of pulmonary physiology, and primitive methods of immunosuppression. These early and disappointing clinical results confined the procedure to the laboratory until other areas of transplantation biology advanced.

Discoveries and advancements in cardiac transplantation were eventually applied to heart-lung transplantation, including the development of rabbit antithymocyte globulin to deter rejection and endomyocardial biopsy techniques to detect rejection.

The discovery and application of cyclosporine A was a turning point. With this new immunosuppressive agent, rejection could be controlled with less steroid use. This development addressed the difficulties incurred in healing of the partially devascularized trachea and constituted a critical step in the reduction of postoperative morbidity and mortality. By capitalizing on these significant advances, human heart-lung transplantation reemerged as a therapeutic alternative for end-stage cardiopulmonary disease.

Candidates for heart-lung transplantation are generally younger persons with a fatal disease. The transplantation process offers hope to these persons. However, the shortage of donor organs makes this lifesaving procedure unavailable to many individuals. Both patients and families need strong physician support, availability, and candor when dealing with issues as they arise.

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