Current status of lung and heart-lung transplantation for pulmonary arterial hypertension

Lung transplantation (LT) or heart-lung transplantation (HLT) had been a mainstay of treatment for pulmonary arterial hypertension (PAH) since the 1980s. Considerable advances in the medical therapy over the past decade, however, changed the paradigm of treatment algorithm for PAH, and LT in any form became a therapeutic option for patients deteriorating despite the best available medical therapy. On the basis of a shortage of available organs for transplantation, most centers prefer bilateral LT to HLT as the procedure of choice. According to the international registry, survival rates following bilateral LT for PAH are 81% at 1 month, 68% at 1 year, and 50% at 5 years. Improvement in the survival rate in early post-operative periods is a matter of critical concern in LT for PAH.