INTRODUCTION G.M. Verleden*, A.J. Fisher#, G. Massard" *Lung Transplantation Unit, University Hospital Gasthuisberg, Leuven, Belgium, # Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK, and " Service de Chirurgie Thoracique, Ho ˆpitaux Universitaires de Strasbourg, Strasbourg, France. Correspondence: G.M. Verleden, University Hospital Gasthuisberg, Dept of Respiratory Medicine, Lung Transplantation Unit, 49 Herestraat, B-3000 Leuven, Belgium. E-mail: geert.verleden@uzleuven.be Six years have elapsed since the previous European Respiratory Monograph (ERM) on Lung Transplantation was published [1]. Since then, many new guidelines have appeared, for example, on the definition, diagnosis and management of primary graft dysfunction [2–7], on the referral of candidates for lung transplantation [8], on donor criteria and especially on the use of marginal donors [9] and the increasing use of donors with nonbeating hearts (or donors after cardiac death) [10]. New immunosuppressive agents have come onto the market, and have proved to be successful, at least in renal and heart transplantation, in further reducing the number of acute rejection episodes. In lung transplantation, however, limited data is available and it is not possible to assume that the same effects will be present. There have also been new insights into the development of bronchiolitis obliterans syndrome (BOS) [11], which still is the major problem after lung transplantation. Indeed, despite serious improvements in operative and peri-operative management, which have led to improved early transplant survival, BOS remains the major complication that hampers long-term survival. There has been renewed interest in the role of neutrophilia in the bronchoalveolar lavage fluid, which has again emerged as a very interesting prognostic sign and risk factor for the development of BOS [12]. Additionally, the neomacrolide azithromycin has been established as a potential treatment for lung transplant patients with BOS, especially for those in whom a bronchoalveolar lavage neutrophilia is present [13, 14]. It was decided to put together a selected team of experts in the field and to produce an updated ERM on Lung Transplantation because of all these recent advances and, especially, because many new lung transplant centres will be established in the near future (for instance, in Eastern Europe). This ERM deals with all aspects of lung transplantation, including current indications and patient selection for lung transplant- ation, donor selection (with emphasis on marginal donor use and measures to increase the donor pool, for example, by the use of donors with nonbeating hearts), immunosuppression (including new immunosuppressive agents), infectious and non- infectious complications, diagnosis, new risk factors and current management of BOS, post-transplant lymphoproliferative disease and other tumours emerging after lung transplantation, outcome and quality of life, and a chapter devoted to specific paediatric aspects of lung transplantation. Although there are many unanswered questions in the field of lung transplantation, we do hope that this ERM may answer some of them and will serve as an updated handbook of how to deal with potential lung transplant candidates, donors and eventually transplanted patients. Eur Respir Mon, 2009, 45, ix–x. Printed in UK - all rights reserved. Copyright ERS Journals Ltd 2009 European Respiratory Monograph ISSN 1025-448x. ix
Previous Page Next Page