Update on lung transplantation: programmes, patients and prospects

The will is infinite and the execution confined…the desire is boundless and the act a slave to limit Shakespere W. Troilus and Cressida . Act III, Scene ii. Discovery consists of seeing what everyone has seen and thinking what nobody has thought Anonymous It has been over 30 yrs since the modern era of lung transplantation commenced and what was then the “new frontier and exceptional” has now become “routine and expected”. Strong vision, bold action and creative thinking have led to outstanding progress in the management of end-stage lung and pulmonary vascular disease. The purpose of this article is to highlight what has been achieved, critically assess where we are in terms of a “cure” for severe lung disease, and (re)stimulate the creative thinking, action and vision that are still very much required to solve the ongoing impediments to achieving a durable lung allograft and long-term recipient survival following the life-giving procedure that lung transplantation is, and can be. ### History and programme evolution: from cottage industry to just expected Lung transplantation has evolved over the last 60 yrs from a series of remarkable animal experiments to an established treatment of severe end-stage lung and pulmonary vascular disease fully funded in many jurisdictions. In its infancy it was swept along by the determination and drive of surgical pioneers. Amongst them the names Demikhov, Hardy, Schumway, Cooley, Reitz, Cooper and Patterson have exemplified the surgeons’ drive to bring lung transplantation to clinical fruition. With long-term survivors of heart–lung transplantation (HLTx) from 1981 [1], single lung transplantation (SLT) from 1983 [2] and bilateral lung transplantation (BLTx) from 1985 [3], this decade saw the true genesis of clinical lung transplant programmes. HLTx became the early option for lung replacement with Stanford University (Stanford, CA, USA) leading the way under the leadership of Bruce Reitz. A second key …