The future of lung transplantation
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Borro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Borro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000822?idApp=UINPBA00004E" "url" => "/21735115/0000002100000003/v2_201505070217/S2173511515000822/v2_201505070217/en/main.assets" ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "The future of lung transplantation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "4" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.M. Borro" "autores" => array:1 [ 0 => array:4 [ "Iniciales" => "J.M." "apellidos" => "Borro" "email" => array:1 [ 0 => "jbormat@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "University of A Coruña, Xubias de Arriba 84, 15006 A Coruña, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara">The first lung transplantation was performed 50 years ago, in 1963, in Jackson, Mississippi<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> and the first long-term survivals were achieved 25 years ago<a href="#bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>. Currently, lung transplantation has been established as an effective therapy for a group of selected patients with advanced-stage lung diseases, when other therapeutic options are no longer useful and there is no other alternative therapy.</p><p class="elsevierStylePara">Present status of lung transplantation is clearly favorable, with an increasing number of transplantation procedures being performed both globally and at a national level, along with a gradually improving short- and long-term survival.</p><p class="elsevierStylePara">Various factors will have a significant impact on the development of lung transplantation in next years</p><p class="elsevierStylePara">Regarding receptors selection, absolute contraindications (hepatitis C, HIV, renal or liver failure) will mostly become relative contraindications in selected cases in the latest revision of ISHLT that is about to be issued. This is particularly true for hepatitis C and HIV; in such patients an appropriate selection of suitable cases and the use of novel antiviral therapies have shown favorable mid-term results<a href="#bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>. Furthermore, combined transplantation allows an acceptable survival to be achieved in selected patients with renal and liver failure<a href="#bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>.</p><p class="elsevierStylePara">Age of receptor is now considered in a more flexible way<a href="#bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> and will possibly be no longer a contraindication. Therefore, ethically appropriate decisions will be taken based on comorbidities or measurable factors such as quality of life, physical exercise tolerance or brain functioning tests.</p><p class="elsevierStylePara">Regarding main diseases to be treated by transplantation, other alternative therapies aim at reducing the amount of candidates to transplantation, because this must always be the last therapeutic option. Recent results from studies of pirfenidone<a href="#bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> in pulmonary fibrosis have shown a potential reduction of the number of patients eligible for transplantation or a prolonged time to transplantation. Several surgical or bronchoscopic procedures for lung volume reduction could also postpone transplantation in emphysema<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>. Even more interestingly, recent investigations on cystic fibrosis therapy<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> could result in a change of the disease course, as has already happened in patients with PPH<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a>.</p><p class="elsevierStylePara">A better use of available donors is one of the most important factors helping lung transplantation to cover currently existing needs<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a>. Thus, an improved care of donors is providing more and better donors and has allowed using some suboptimal donors; nevertheless, the decision to accept a suboptimal donor should always ensure a survival similar to the usual one<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a>. Donation in asystole has shown similar survival results, and is now a reality that should increase in the future after asystole method is established in most medium-size towns.</p><p class="elsevierStylePara">The most important development in the near future could probably be <span class="elsevierStyleItalic">ex vivo</span> preservation allowing an appropriate assessment of donor organs to be carried out and prolonging ischemia time to 12 or more hours, while donor lungs are treated for neurogenic edema, mild contusions, and even some types of pulmonary infections<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a>. The use of various <span class="elsevierStyleItalic">ex vivo</span> systems being currently tested, along with the creation of specific donor lung therapy units, will probably transform the future of lung donation.</p><p class="elsevierStylePara">In the long-term, one of the most attractive proposals could be the development of engineered bio-synthetic lungs, by means of growing epithelial and endothelial cells on a decellularized lung skeleton, thus allowing an appropriate ventilation, perfusion, and gas exchange<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a>.</p><p class="elsevierStylePara">In conclusion, lung transplantation is having a consistent development with current lines for research being mainly focused on improving the use of potential donors and treating chronic rejection, still the main problems for lung transplantation development.</p><hr></hr><p class="elsevierStylePara">☆ Please cite this article as: Borro J.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 53 | 29 | 82 |
| 2024 September | 50 | 19 | 69 |
| 2024 August | 62 | 39 | 101 |
| 2024 July | 47 | 41 | 88 |
| 2024 June | 56 | 23 | 79 |
| 2024 May | 52 | 35 | 87 |
| 2024 April | 55 | 32 | 87 |
| 2024 March | 48 | 24 | 72 |
| 2024 February | 58 | 15 | 73 |
| 2024 January | 55 | 28 | 83 |
| 2023 December | 42 | 26 | 68 |
| 2023 November | 43 | 37 | 80 |
| 2023 October | 45 | 30 | 75 |
| 2023 September | 42 | 27 | 69 |
| 2023 August | 37 | 26 | 63 |
| 2023 July | 42 | 32 | 74 |
| 2023 June | 40 | 19 | 59 |
| 2023 May | 55 | 30 | 85 |
| 2023 April | 59 | 13 | 72 |
| 2023 March | 120 | 15 | 135 |
| 2023 February | 49 | 22 | 71 |
| 2023 January | 28 | 28 | 56 |
| 2022 December | 58 | 23 | 81 |
| 2022 November | 59 | 34 | 93 |
| 2022 October | 75 | 45 | 120 |
| 2022 September | 38 | 27 | 65 |
| 2022 August | 40 | 51 | 91 |
| 2022 July | 47 | 52 | 99 |
| 2022 June | 41 | 34 | 75 |
| 2022 May | 41 | 40 | 81 |
| 2022 April | 42 | 25 | 67 |
| 2022 March | 47 | 40 | 87 |
| 2022 February | 41 | 43 | 84 |
| 2022 January | 44 | 30 | 74 |
| 2021 December | 34 | 38 | 72 |
| 2021 November | 33 | 26 | 59 |
| 2021 October | 43 | 38 | 81 |
| 2021 September | 31 | 31 | 62 |
| 2021 August | 44 | 24 | 68 |
| 2021 July | 39 | 25 | 64 |
| 2021 June | 36 | 27 | 63 |
| 2021 May | 55 | 27 | 82 |
| 2021 April | 135 | 61 | 196 |
| 2021 March | 75 | 14 | 89 |
| 2021 February | 63 | 10 | 73 |
| 2021 January | 48 | 16 | 64 |
| 2020 December | 48 | 10 | 58 |
| 2020 November | 44 | 16 | 60 |
| 2020 October | 46 | 15 | 61 |
| 2020 September | 58 | 30 | 88 |
| 2020 August | 54 | 22 | 76 |
| 2020 July | 110 | 20 | 130 |
| 2020 June | 99 | 17 | 116 |
| 2020 May | 106 | 21 | 127 |
| 2020 April | 84 | 9 | 93 |
| 2020 March | 81 | 12 | 93 |
| 2020 February | 70 | 14 | 84 |
| 2020 January | 73 | 17 | 90 |
| 2019 December | 76 | 21 | 97 |
| 2019 November | 86 | 14 | 100 |
| 2019 October | 81 | 24 | 105 |
| 2019 September | 84 | 21 | 105 |
| 2019 August | 174 | 14 | 188 |
| 2019 July | 175 | 10 | 185 |
| 2019 June | 194 | 10 | 204 |
| 2019 May | 184 | 22 | 206 |
| 2019 April | 152 | 21 | 173 |
| 2019 March | 247 | 18 | 265 |
| 2019 February | 212 | 10 | 222 |
| 2019 January | 180 | 28 | 208 |
| 2018 December | 101 | 5 | 106 |
| 2018 November | 32 | 2 | 34 |
| 2018 October | 53 | 14 | 67 |
| 2018 September | 29 | 5 | 34 |
| 2018 August | 39 | 24 | 63 |
| 2018 July | 47 | 22 | 69 |
| 2018 June | 55 | 17 | 72 |
| 2018 May | 91 | 22 | 113 |
| 2018 April | 73 | 15 | 88 |
| 2018 March | 68 | 15 | 83 |
| 2018 February | 35 | 11 | 46 |
| 2018 January | 51 | 20 | 71 |
| 2017 December | 57 | 11 | 68 |
| 2017 November | 25 | 20 | 45 |
| 2017 October | 14 | 17 | 31 |
| 2017 September | 25 | 16 | 41 |
| 2017 August | 19 | 18 | 37 |
| 2017 July | 21 | 16 | 37 |
| 2017 June | 28 | 17 | 45 |
| 2017 May | 27 | 16 | 43 |
| 2017 April | 11 | 6 | 17 |
| 2017 March | 11 | 4 | 15 |
| 2017 February | 7 | 6 | 13 |
| 2017 January | 10 | 10 | 20 |
| 2016 December | 14 | 14 | 28 |
| 2016 November | 8 | 7 | 15 |
| 2016 October | 7 | 1 | 8 |
| 2016 September | 5 | 1 | 6 |
| 2016 August | 3 | 3 | 6 |
| 2016 July | 4 | 8 | 12 |
| 2016 June | 9 | 3 | 12 |
| 2016 May | 6 | 6 | 12 |
| 2016 April | 41 | 1 | 42 |
| 2016 March | 54 | 36 | 90 |
| 2016 February | 49 | 27 | 76 |
| 2016 January | 42 | 25 | 67 |
| 2015 December | 49 | 24 | 73 |
| 2015 November | 39 | 5 | 44 |
| 2015 October | 47 | 15 | 62 |
| 2015 September | 34 | 18 | 52 |
| 2015 August | 31 | 13 | 44 |
| 2015 July | 25 | 7 | 32 |
| 2015 June | 26 | 6 | 32 |
| 2015 May | 32 | 12 | 44 |
| 2015 April | 49 | 40 | 89 |
| 2015 March | 95 | 35 | 130 |
| 2015 February | 71 | 62 | 133 |
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