330 Ch 329. Lung Transplantation

Lung transplantation 是 end-stage lung disease 唯一治癒性治療；indications：IPF (most common)、COPD、CF、PAH、α1-antitrypsin deficiency、bronchiectasis、ILD (CTD-associated, HP fibrotic, sarcoidosis)、Eisenmenger syndrome、re-transplant；bilateral lung transplant preferred (vs single) for most；heart-lung transplant for Eisenmenger + biventricular failure；organ allocation：LAS (Lung Allocation Score) — based on urgency + transplant benefit；listing criteria：FVC < 50% IPF, FEV1 < 30% COPD, hypoxemia, hypercapnia, PH (severe), recurrent exacerbations；contraindications：active malignancy < 5 yr, severe comorbidities, active substance abuse, severe psychosocial issues, BMI > 30-35；immunosuppression：CNI (tacrolimus) + antiproliferative (MMF) + steroid；outcomes：1-yr 85%, 5-yr 55%, 10-yr 30% (improving)；complications：primary graft dysfunction (PGD), acute rejection (cellular, antibody-mediated), chronic lung allograft dysfunction (CLAD = BOS + RAS), infection (CMV, fungal, BK), malignancy (PTLD, skin), renal dysfunction；ex-vivo lung perfusion (EVLP) + DCD donors expanding donor pool。