Human lung transplantation was first attempted in a 58-year-old male smoker and prison (life sentence) inmate with lung cancer, described by Hardy in 1963.<sup>20Hardy J.D., Webb W.R., Dalton M.L., et al. Lung homotransplantation in man JAMA 1963 ;  186 : 1065-1074

Cliquez ici pour aller à la section Références</sup> The man was breathless on minimal exertion and thought unable to physiologically survive resection without lung transplantation. At operation, it was discovered that the cancer could not be fully resected but it was decided to continue with the left lung homotransplantation. The graft functioned adequately, with immediate improvement in arterial blood gases, but the recipient died of renal failure on day 18. From that time, more than 40 attempts at lung transplant were made; only two survived beyond 2 months (6 and 10 months). One recipient survived 10 months but spent only a few weeks out of hospital<sup>12Deron F., Barbier F., Ringoir S., et al. Ten months' survival after lung homotransplantation J Thorac Cardiovasc Surg 1971 ;  61 : 835-846

Cliquez ici pour aller à la section Références</sup>; nevertheless, the reality of long-term graft function was well demonstrated.

In 1982, the Stanford University group<sup>56Reitz B.A., Wallwork J.W., Hunt S.A., et al. Heart–lung transplantation: Successful therapy for patients with pulmonary vascular disease N Engl J Med 1982 ;  306 : 557-564 [cross-ref]

Cliquez ici pour aller à la section Références</sup> reported the results of heart–lung transplantation (HLTx) in three patients, and two with pulmonary vascular disease achieved long-term quality survival. Many factors contributed to the group's success, including preliminary experience with the procedure in primates and the availability of the immunosuppressing agent cyclosporine A. Over the next decade, isolated lung transplantation procedures were developed and performed successfully in humans. Single lung transplantation (SLTx) was first successfully performed in 1993 by the Toronto Lung Transplant Group,<sup>72Toronto Lung Transplant Group Unilateral lung transplantation for pulmonary fibrosis N Engl J Med 1986 ;  314 : 1140-1145

Cliquez ici pour aller à la section Références</sup> initially in recipients with pulmonary fibrosis (PF) but subsequently for pulmonary hypertension (PH) and, more recently, for obstructive lung disease (OLD). Double lung transplantation was first performed in 1985<sup>52Patterson G.A., Cooper J.D., Goldman B., et al. Technique of successful clinical double lung transplantation Ann Thorac Surg 1988 ;  45 : 626-632 [cross-ref]

Cliquez ici pour aller à la section Références</sup> as an en bloc procedure with tracheal anastomosis, initially for patients with bronchiectasis (especially cystic fibrosis [CF]) and bullous emphysema.

The en bloc double lung transplant procedure carried a high rate of tracheal anastomotic breakdown, with many fatalities. In 1989, the procedure was modified to the bilateral sequential lung transplant (BLTx) procedure predominantly used for double lung replacement today. A few groups persist with en bloc double lung transplantation, with revascularization of the bronchial circulation employing the internal mammary artery.<sup>70Svendsen U., Arendrup H., Norgaard M., et al. Double lung transplantation with bronchial artery revascularization using mammary artery Transplant Proc 1995 ;  27 : 3485

Cliquez ici pour aller à la section Références</sup>

Live-donor lobar transplantation was first performed by Starnes et al<sup>15Goldsmith M.F. Mother to child: First living donor lung transplant JAMA 1990 ;  264 : 2724

Cliquez ici pour aller à la section Références</sup> in a 12-year-old girl receiving a lobar transplant from her mother for bronchopulmonary dysplasia. More recently, successful bilateral transplantation with the right lower lobe from one living donor and left lower lobe from a second living donor, has been reported by the University of Southern California group.<sup>3Barr M.L., Schenkel F.A., Cohen R.G., et al. Living-related lobar transplantation: Recipient outcome and early rejection patterns Transplant Proc 1995 ;  27 : 1995-1996

Cliquez ici pour aller à la section Références</sup> Although first-degree relatives initially were used, unrelated lobar donors are now used. Patients often have CF and are deteriorating rapidly, with insufficient time to wait for a cadaveric donor. Long-term survival with good functional capacity has been reported.

Other procedures have been reported, including en bloc heart–lung–liver and bilateral lung–liver transplantation. Bilateral lobar transplantation (using left upper and lower lobes of a cadaveric donor) in combination with liver transplantation has also been reported.<sup>9Couetil J.P., Houssin D.P., Soubrane O., et al. Combined lung and liver transplantation in patients with cystic fibrosis: A 4½-year experience J Thorac Cardiovasc Surg 1995 ;  110 : 1415-1422 [cross-ref]

Cliquez ici pour aller à la section Références</sup> These procedures have been performed very infrequently and few outcome data exist.

Pulmonary xenotransplantation, most likely swine to human, has moved outside the realm of “science fiction” and may be a clinical reality in the next decade.

The results of lung transplantation have improved substantially in the 15-year era of successful human lung transplantation. The biggest impact seems to be on the early outcome. The development of bronchiolitis obliterative syndrome (BOS) in the allograft remains the most important determinant of long-term survival and quality of life. Lung retransplantation for BOS is becoming increasingly prevalent.