Essentials of Lung Transplantation

Dr Saskia Bos, MD, PhD, worked from 2020 to 2024 as a clinical researcher at Newcastle University and as a transplant physician at the Institute of Transplantation of the Freeman Hospital, Newcastle upon Tyne, UK. She then moved back to Belgium, where she now works as a transplant pulmonologist in the Leuven Lung Transplant Program and is Adjunct Head of Clinic of the Department of Respiratory Diseases at the University Hospitals Leuven. She has a specific interest in chronic lung allograft dysfunction, pulmonary graft-versus-host disease after haematopoietic stem cell transplantation and infectious diseases in solid organ transplants. She is active in several European and International Societies (European Respiratory Society, European Society for Organ Transplantation, International Society for Heart and Lung Transplantation, and European Society of Clinical Microbiology and Infectious Diseases).Robin Vos, MD, PhD, is Medical Director of the Leuven Lung Transplant Program, Deputy Head of Clinic of the Department of Respiratory Diseases at the University Hospitals Leuven and Associate Professor of Medicine at KU Leuven, Belgium. He is a Senior Clinical Research Fellow of the Research Foundation - Flanders and his clinical and translational research focuses on the pathophysiology and treatment of chronic lung allograft dysfunction and pulmonary chronic graft-versus-host-disease. He is a Fellow of the European Respiratory Society (FERS) and active in several European and International Societies (Eurotransplant, European Respiratory Society, European Society for Organ Transplantation, and International Society for Heart and Lung Transplantation).Andrew J. Fisher, FRCP, PhD, is Professor of Respiratory Transplant Medicine at Newcastle University and a transplant pulmonologist at the Institute of Transplantation at Freeman Hospital, Newcastle upon Tyne, UK with almost 30 years of experience. He is Co-Director of the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation and leads a team of scientists and clinicians who are working on better understanding how outcomes after lung transplantation can be improved. He has led education initiatives on lung transplantation for the European Respiratory Society, British Thoracic Society and International Society for Heart and Lung Transplantation (ISHLT) and is a Past President of ISHLT.

• 1. Lung transplantation. 1.1 Lung transplantation: where are we today? 1.2 Ethical considerations regarding lung transplantation. 2. Pre-transplant. 2.1 Indications for lung transplantation. 2.2 How to select a good recipient? 2.3 A patient on the waiting list: how to manage and when to transplant. 2.4 How are organs allocated? 2.5 How to select a good donor? 3. Peri-transplant. 3.1 Type of lung transplantation. 3.2 Type of procedure. 3.3 ECMO, cardiopulmonary bypass and off-pump. 3.4 What is ischaemia time? 3.5 Should we use ex vivo lung perfusion? 3.6 To induce or not? 4. Post-transplant medication and follow-up. 4.1 Maintenance immunosuppression. 4.2 Prophylaxis. 4.3 What to expect after lung transplantation?. 4.4 General follow-up post-transplant. 4.5 Surgery in lung transplant patients. 4.6 Pregnancy and lung transplantation. 4.7 Medication interactions. 5. General post-operative complications and primary graft dysfunction . 5.1Pleural complications. 5.2 Ischaemic airway complications and fistulas. 5.3 Other post-operative complications. 5.4 Primary graft dysfunction (PGD). 6. Post-transplant complications: rejection. 6.1 Introduction acute and chronic rejection. 6.2 Hyperacute rejection: does it still exist?.6.3 Acute cellular rejection (ACR). 6.4 Donor specific antibodies (DSA): what and how to interpret?6.5 Antibody-mediated rejection (AMR). 6.6 Chronic rejection: chronic lung allograft dysfunction (CLAD). 6.7 Bronchiolitis obliterans syndrome (BOS). 6.8 Restrictive allograft syndrome (RAS). 6.9 Biomarkers and future therapies. 7. Other common post-transplant complications. 7.1 Infections. 7.2 Malignancies. 7.3 Kidney dysfunction. 7.4Metabolic complications and cardiovascular disease. 7.5 Reflux and other gastrointestinal issues: why it matters. 7.6 PRES: posterior reversible encephalopathy syndrome. 8. Clinical cases. 1.3Clinical case: early post-operative evolution. 1.4 Clinical case: ACR, infection and CLAD . 1.5Clinical case: CMV infection. 1.6 Clinical case: PTLD