The Changing Landscape of Lung Transplantation

Lung transplantation is increasingly used as a last resort treatment for end-stage chronic lung diseases. In the last decade, important improvements have been noted in terms of surgical techniques and perioperative and postoperative management, as well as greater acceptance of older recipients. However, the most drastic changes are observed in recipient and donor profiles due to advances in the treatment of chronic lung diseases. Such advances include novel patient stratification systems, such as the concept of progressive fibrosing interstitial lung diseases in pulmonary fibrosis; novel findings regarding etiology of disease, such as telomere length in pulmonary fibrosis; novel pharmaceutical treatment options, such as CFTR modulators in cystic fibrosis; and novel interventions, such as lung volume reduction in chronic obstructive pulmonary disease, and endarterectomy and balloon angioplasty in chronic thromboembolic pulmonary hypertension. In this review, the authors discuss the latest developments in the management of chronic lung diseases and how this affects recipient profiles and lung transplant management. Finally, the authors point out the uncertainties and knowledge gaps in these developments regarding transplant management.