ISOLATED LUNG TRANSPLANTATION: A REVIEW OF PROBLEMS AND GUIDE TO ANAESTHESIA

The recent success of the Toronto Lung Trans-plant Group with isolated human lung trans-plantation [1,2] is the culmination of the work of more than two decades in various centres through-out the world [3]. Factors that have led to recent recipients in North America and in Europe [4] being able to leave hospital with their symptoms improved by operation, include better techniques of donor lung preservation, more effective surgical techniques for the preservation of bronchial anastomoses [5], a greater dependence on cyclo-sporin for the control of early rejection pheno-mena [6], better management of respiratory failure before and after operation, and control of infec-tion. Anaesthetists have a role, crucial to success, at several key points in the management of the patients with severely compromised lung function who are likely to be accepted into a lung transplantation programme. PATIENT SELECTION Patients whose disease is such that they are in or approaching end-stage pulmonary failure are potential recipients. Those with significant car-diac disease or marked increases in pulmonary artery pressure secondary to cardiac pathology are more suited for selection for heart-lung trans-plantation [7,8]. Those whose main disability is secondary to conditions that result in chronic sepsis, such as cystic fibrosis or bronchiectasis, are likely to have residual foci of infection after transplantation which will be exacerbated by immunotherapy. Bilateral lung transplantation offers the best prognosis for these patients, as it does for some of those having adult respiratory distress syndrome, bilateral emphysematou