Topic Map

1. Indications & contraindications (ESLD, ALF, HCC, MELD/UNOS criteria)
2. Donor selection & graft types (deceased/DBD-DCD, living-donor, split-liver)
3. Surgical technique (orthotopic liver transplant - OLT, vascular/biliary anastomoses)
4. Immunosuppression protocols
5. Complications - vascular (hepatic artery thrombosis/stenosis, portal vein thrombosis), biliary (leaks, ischemic strictures), rejection (acute cellular, chronic ductopenic), infections
6. Post-transplant surveillance, recurrence of primary disease, long-term outcomes/survival

1. Indications & contraindications (COPD, IPF/ILD, cystic fibrosis, pulmonary hypertension) and LAS (Lung Allocation Score)
2. Types of transplant (single vs bilateral vs heart-lung)
3. Surgical considerations & donor-recipient matching
4. Immunosuppression
5. Complications - primary graft dysfunction, acute rejection, chronic lung allograft dysfunction (bronchiolitis obliterans syndrome / restrictive allograft syndrome), infections (CMV, fungal), airway complications
6. Outcomes/survival (lung transplant has the worst 5-year survival of all solid organ transplants, ~60%)

Brief Overview

Topic Map

1. Indications & contraindications (ESLD, ALF, HCC, MELD/UNOS criteria)
2. Donor selection & graft types (deceased/DBD-DCD, living-donor, split-liver)
3. Surgical technique (orthotopic liver transplant - OLT, vascular/biliary anastomoses)
4. Immunosuppression protocols
5. Complications - vascular (hepatic artery thrombosis/stenosis, portal vein thrombosis), biliary (leaks, ischemic strictures), rejection (acute cellular, chronic ductopenic), infections
6. Post-transplant surveillance, recurrence of primary disease, long-term outcomes/survival

1. Indications & contraindications (COPD, IPF/ILD, cystic fibrosis, pulmonary hypertension) and LAS (Lung Allocation Score)
2. Types of transplant (single vs bilateral vs heart-lung)
3. Surgical considerations & donor-recipient matching
4. Immunosuppression
5. Complications - primary graft dysfunction, acute rejection, chronic lung allograft dysfunction (bronchiolitis obliterans syndrome / restrictive allograft syndrome), infections (CMV, fungal), airway complications
6. Outcomes/survival (lung transplant has the worst 5-year survival of all solid organ transplants, ~60%)

Brief Overview

Topic Map

1. Indications & contraindications (ESLD, ALF, HCC, MELD/UNOS criteria)
2. Donor selection & graft types (deceased/DBD-DCD, living-donor, split-liver)
3. Surgical technique (orthotopic liver transplant - OLT, vascular/biliary anastomoses)
4. Immunosuppression protocols
5. Complications - vascular (hepatic artery thrombosis/stenosis, portal vein thrombosis), biliary (leaks, ischemic strictures), rejection (acute cellular, chronic ductopenic), infections
6. Post-transplant surveillance, recurrence of primary disease, long-term outcomes/survival

1. Indications & contraindications (COPD, IPF/ILD, cystic fibrosis, pulmonary hypertension) and LAS (Lung Allocation Score)
2. Types of transplant (single vs bilateral vs heart-lung)
3. Surgical considerations & donor-recipient matching
4. Immunosuppression
5. Complications - primary graft dysfunction, acute rejection, chronic lung allograft dysfunction (bronchiolitis obliterans syndrome / restrictive allograft syndrome), infections (CMV, fungal), airway complications
6. Outcomes/survival (lung transplant has the worst 5-year survival of all solid organ transplants, ~60%)

Brief Overview

LIVER & LUNG TRANSPLANT — Complete Detailed Notes

PART 1: LIVER TRANSPLANTATION

1. Indications

• Chronic end-stage liver disease (ESLD): cirrhosis of any cause (viral hepatitis B/C, alcohol-related, NASH, autoimmune, cholestatic - PBC/PSC, metabolic) with decompensation (ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome).
• Acute liver failure (ALF): fulminant hepatic failure from drug toxicity (e.g., acetaminophen), viral hepatitis, or indeterminate causes.
• Hepatocellular carcinoma (HCC): transplant is curative when tumor burden is within the Milan criteria - single tumor ≤5 cm, or up to 3 tumors each ≤3 cm, without extrahepatic spread or vascular invasion. Patients beyond Milan criteria have been studied for expanded criteria with variable outcomes - Fischer's Mastery of Surgery, p. 3461-3535.
• Metabolic liver disease: Wilson disease, alpha-1 antitrypsin deficiency, hereditary hemochromatosis, primary hyperoxaluria.
• Hepatitis B and C recipients require post-transplant antiviral management - Goldman-Cecil Medicine, p. 589.

2. Evaluation & Allocation - MELD Score

• The Model for End-Stage Liver Disease (MELD) score is used by UNOS to prioritize patients on the waiting list, derived from a formula incorporating bilirubin, INR, and creatinine (sodium is incorporated in MELD-Na). Score ranges from roughly 6-40.
• Mortality risk rises with higher MELD: <5% mortality with MELD <11, ~20% mortality with MELD ≥19 - Yamada's Textbook of Gastroenterology, p. 1853.
• MELD is also used for prognostication before other procedures (e.g., elective TIPS) - Grainger & Allison's Diagnostic Radiology, p. 3947-3951.

3. Types of Transplant

• Deceased donor orthotopic liver transplant (OLT) - most common.
• Living donor liver transplant - partial graft (commonly right lobe) from a living donor.
• Split-liver transplant - one deceased-donor liver divided between two recipients (often adult + pediatric).

4. Surgical Considerations

• The biliary tree receives its entire blood supply from the hepatic artery after OLT (no dual portal supply as in the native liver) — this is why arterial complications so severely threaten the bile ducts - Sleisenger and Fordtran's Gastrointestinal and Liver Disease, p. 1136-1145.
• Vascular anastomoses: hepatic artery, portal vein, IVC (or piggyback technique), plus biliary anastomosis (duct-to-duct or Roux-en-Y hepaticojejunostomy).

5. Immunosuppression

• Induction: high-dose intraoperative corticosteroids.
• Maintenance: tacrolimus + mycophenolate mofetil + steroid taper over 3-6 months. By 6-12 months, many stable recipients are tapered to a single calcineurin inhibitor (tacrolimus or cyclosporine) - Goldman-Cecil Medicine, p. 594-596.
• mTOR inhibitors (sirolimus, everolimus) may be combined with low-dose calcineurin inhibitor to reduce nephrotoxicity.
• Notably, "rejection of the liver (unlike other transplanted organs) does not adversely affect patient or graft survival rates" as strongly as in other organs — the liver is considered the most "tolerogenic" solid organ allograft - Schwartz's Principles of Surgery, p. 402-405; Yamada's Textbook of Gastroenterology, p. 2567.
• Drug interaction caution: calcineurin/mTOR inhibitors are metabolized by CYP3A4/5 — azoles, macrolides, non-dihydropyridine CCBs, and amiodarone raise levels; rifampin, St. John's wort, carbamazepine/phenytoin lower levels - Goldman-Cecil Medicine, p. 598-602.

6. Complications

• Hepatic artery thrombosis (HAT): occurs in 5-9% of adult recipients; spectrum from asymptomatic transaminase elevation to acute hepatic failure requiring urgent retransplantation. Loss of arterial flow → bile duct necrosis, leakage, bilomas/abscesses, and can mimic ductopenic rejection.
• Portal vein thrombosis: reported in up to 12% of transplants; early occurrence risks severe hepatic dysfunction (Sleisenger and Fordtran's Gastrointestinal and Liver Disease, p. 1136-1147).

• Biliary strictures (often ischemic, from arterial compromise) and biliary leaks. Deceased-donor leaks typically occur at the anastomosis (bilomas, bile peritonitis); living-donor/split-graft leaks occur more along the cut liver surface. Diagnosis via ERCP/MRCP; treated with percutaneous drainage plus endoscopic or transhepatic biliary stenting (Yamada's Textbook of Gastroenterology, p. 2561-2562).

• Hyperacute rejection: rare, minutes-hours, due to preformed anti-HLA/ABO antibodies; essentially eliminated by pretransplant crossmatching.
• Acute cellular rejection (ACR): occurs in 15-25% of recipients (up to 20% cited in some sources within the first year). ~50% of episodes occur by 6 weeks, 65% by 1 year. Presents with transaminase elevation, fever, malaise; diagnosed by liver biopsy (portal inflammation, bile duct injury, endothelial inflammation), graded by Banff score. Early ACR (<28 days) does not adversely affect outcome; late ACR correlates with worse survival. Treated with IV steroid bolus ± optimizing calcineurin inhibitor levels; refractory cases may need anti-T-cell antibody therapy (Yamada's Textbook of Gastroenterology, p. 2567-2571; ROSEN's Emergency Medicine, p. 2401).
• Antibody-mediated rejection: due to donor-specific antibodies; treated with increased immunosuppression, plasmapheresis, or IV immunoglobulin.
• Chronic ductopenic rejection: results from repeated ACR episodes, causing bile duct obliteration; slower to improve, may require retransplant.

• Early period: bacterial infections (bloodstream, lungs, biliary tree, fluid collections), fungal infections (mostly Candida, associated with biliary/bleeding complications), later invasive aspergillosis in high-risk settings (fulminant failure, retransplant, renal failure).
• Multidrug-resistant gram-negative organisms are an emerging major threat (Yamada's Textbook of Gastroenterology, p. 2574-2578).

• GI complications: intra-abdominal hemorrhage, bowel perforation/obstruction, GI bleeding.
• Drug hepatotoxicity: caution with rifamycins, isoniazid, azoles; acetaminophen limited to ≤4 g/day; NSAIDs discouraged.
• Calcineurin inhibitor-induced nephrotoxicity (renal vasoconstriction) is common; reducing immunosuppression to protect kidneys risks rejection (Sleisenger and Fordtran's Gastrointestinal and Liver Disease, p. 517-522).

PART 2: LUNG TRANSPLANTATION

1. Indications by Disease

• COPD/emphysema and idiopathic pulmonary fibrosis (IPF) were historically the most common indications; interstitial lung disease (ILD) (including IPF and non-IIP ILD) has now overtaken COPD as the leading global indication (32.4% ILD/IIP + 8.1% non-IIP ILD vs. COPD 30.1%), with ILD accounting for 47% of North American transplants vs 38% a decade prior. Cystic fibrosis (15.2%) and alpha-1 antitrypsin deficiency (4.7%) are other major indications (Barash, Cullen & Stoelting's Clinical Anesthesia, p. 2267).
• Chronic hypersensitivity pneumonitis: transplant indicated with progressive disease despite management; outcomes are actually better than IPF, though recurrence risk in the allograft is low (Murray & Nadel's Textbook of Respiratory Medicine, p. 949-951).
• Primary pulmonary hypertension: listing deferred if patients respond to IV epoprostenol/vasodilators; listed once NYHA class III/IV symptoms persist or mean PA pressure >75 mmHg.
• Timing thresholds: COPD patients considered when FEV1 <25% predicted (earlier if significant pulmonary hypertension); IPF patients referred when FVC <60% or DLCO <50% predicted (Schwartz's Principles of Surgery, p. 2643-2645).

2. Evaluation & Allocation

• The Lung Allocation Score (LAS), instituted in 2005, replaced simple waiting-time-based allocation. It balances expected survival benefit (waitlist urgency vs. post-transplant survival), based on disease-specific and patient-specific factors. This shortened waiting times, increased transplant volume, and decreased waitlist mortality, without changing overall post-transplant survival (Goldman-Cecil Medicine, p. 278-280; Schwartz's Principles of Surgery, p. 571).
• Evaluation includes extensive pulmonary function testing, 6-minute walk test, chest CT, V/Q scanning, arterial blood gases, cardiac function assessment, and psychosocial evaluation.
• Donor screening: blood type/size match, PaO2 >300 mmHg on FiO2 100% with PEEP 5, ideally normal chest X-ray.

3. Types of Transplant

• Since double-lung transplantation shows improved outcomes, its use has steadily increased relative to single-lung transplant over the past two decades (Barash, Cullen & Stoelting's Clinical Anesthesia, p. 2263-2273).
• Surgical anastomoses: main bronchus/bronchi, pulmonary artery, and pulmonary veins-to-left atrium. Cardiopulmonary bypass or ECMO used selectively when poor pulmonary reserve prevents single-lung ventilation during the procedure.

4. Immunosuppression

• Standard triple regimen: calcineurin inhibitor (tacrolimus or cyclosporine) + antimetabolite (azathioprine or mycophenolate mofetil) + corticosteroids. Over half of centers add induction antilymphocyte antibody therapy, associated with a small long-term survival benefit (Goldman-Cecil Medicine, p. 288-290).

5. Primary Graft Dysfunction (PGD)

• Defined as radiographic pulmonary opacities with impaired oxygenation within 72 hours of transplant, without an identifiable alternative cause (volume overload, pneumonia, rejection, cardiogenic edema). Represents ischemia-reperfusion injury with a diffuse alveolar damage histologic pattern.
• Graded 0-3 by PaO2/FiO2 ratio (Grade 3: PaO2/FiO2 <200 with radiographic edema).
• Occurs severely (Grade 3) in 10-20% of cases, with associated mortality of 20-40% - a leading cause of early post-transplant death.
• Risk factors: high FiO2 at reperfusion, cardiopulmonary bypass use, single-lung transplant, large-volume transfusion, recipient sarcoidosis/pulmonary hypertension/obesity, donor smoking history, elevated donor BAL IL-8.
• Treatment: supportive - low-tidal-volume ventilation, ECMO for refractory cases; inhaled nitric oxide helps established injury but doesn't prevent it prophylactically (Murray & Nadel's Textbook of Respiratory Medicine, p. 481-491).

6. Rejection

• Graded histologically A0 (none) to A4 (severe) based on perivascular mononuclear infiltrates.

• Mediated by donor-specific anti-HLA antibodies (mostly class II). Diagnostic criteria: circulating DSA + allograft dysfunction + compatible histopathology (neutrophilic capillaritis, diffuse alveolar damage) + C4d deposition. Treated with plasmapheresis, IVIG, and rituximab; many progress to chronic allograft dysfunction despite treatment (Murray & Nadel's Textbook of Respiratory Medicine, p. 641).

• Bronchiolitis obliterans syndrome (BOS) is the most common cause of CLAD and the major long-term barrier to graft/patient survival - a fibroproliferative process causing submucosal inflammation/fibrosis and irreversible airway obliteration. Defined functionally as a sustained FEV1 fall ≥20% from post-transplant baseline (since histology is hard to obtain via transbronchial biopsy).
• Approximately 50% of recipients develop BOS by 5 years and 75% by 10 years. Major risk factor: prior acute cellular rejection and lymphocytic bronchiolitis (Murray & Nadel's Textbook of Respiratory Medicine, p. 658-660).
• A second CLAD phenotype, restrictive allograft syndrome (RAS), is also recognized (with distinct radiographic restrictive pattern), though not covered as extensively in retrieved sources.

7. Infections

• Leading cause of death in the early post-transplant period.
• First 3 months: bacterial infections dominate (~1/3 develop pneumonia in first weeks, 75% gram-negative organisms). Chronic rejection predisposes to recurrent Pseudomonas colonization.
• CMV: most important viral pathogen; seronegative recipients of seropositive-donor organs are at highest risk.
• EBV: linked to post-transplant lymphoproliferative disorder (PTLD).
• Aspergillus: most common invasive fungal infection; high-risk patients may receive prophylactic inhaled amphotericin B (Goldman-Cecil Medicine, p. 293-299).

8. Outcomes/Survival

• Lung transplant carries the worst outcomes of any solid organ transplant.
• OPTN data (2008-2015): 1-year survival 87.7%, 3-year 71.8%, 5-year 58.6% for double-lung recipients; median survival 6.2 years overall, with bilateral outperforming single-lung transplant (median 7.1 vs 4.5 years) (Barash, Cullen & Stoelting's Clinical Anesthesia, p. 2267).
• Other sources cite roughly 60% 5-year survival and ~85%/68%/56% at 1/3/5 years in slightly different cohorts (Murray & Nadel's Textbook of Respiratory Medicine, p. 2477; ROSEN's Emergency Medicine, p. 2413).
• Acute rejection occurs in ~30% of recipients and is a major driver of CLAD, which in turn drives most long-term mortality.
• Up to 45% of recipients present to the ED and 67% face readmission within the first year, most often for airway complications, infection, or atrial fibrillation (ROSEN's Emergency Medicine, p. 2413).

Quick Comparison Table

Recent Evidence Check (PubMed, last 2 years, systematic reviews/meta-analyses)

• Liver transplant immunosuppression withdrawal outcomes - systematic review/IPD meta-analysis (PMID: 37905605, 2024).
• mTOR inhibitors in pediatric liver transplant recipients - systematic review (PMID: 39251556, 2024).
• Immunosuppression protocols for oncologic (HCC/cholangiocarcinoma) indications in liver transplant (PMID: 39347698, 2025).
• Tacrolimus vs cyclosporine in lung transplantation - systematic review and meta-analysis, favoring tacrolimus-based regimens as reflected in the notes above (PMID: 40216413, 2025).
• Respiratory oscillometry for monitoring lung allograft function - emerging non-invasive tool for CLAD detection, not yet standard of care (PMID: 41534887, 2026).

KIDNEY TRANSPLANTATION — Complete Detailed Notes

1. Indications & Candidate Evaluation

• Indication: kidney transplantation is the treatment of choice for end-stage kidney disease (ESKD) - superior to maintenance dialysis in life expectancy, quality of life, and cost (Brenner and Rector's The Kidney, p. 1610; Schwartz's Principles of Surgery, p. 2801).
• Candidate evaluation covers: cardiovascular risk (routine cardiac testing if age >50 or diabetic), urologic suitability, cancer screening, infection risk, and overall frailty.
• Contraindications: active uncontrolled infection, untreatable cancer, advanced treatable cardiac disease, cirrhosis, advanced chronic lung disease, psychosocial inability to adhere to the post-transplant regimen, and poor perioperative risk.
• Patients with concurrent advanced liver, lung, or cardiac disease may be candidates for combined organ transplants (liver-kidney, lung-kidney, heart-kidney) - Goldman-Cecil Medicine, p. 3305-3307.

2. Organ Type & Allocation

• Organs allocated first by ABO blood type match, then locally, regionally, and nationally.
• Points/priority based on waiting time, degree of HLA sensitization (PRA), medical urgency, and special status (pediatric patients, prior living donors, prior liver transplant recipients).
• Estimated Post-Transplant Survival (EPTS) score (based on recipient age, dialysis time, diabetes status, and prior transplant history) is matched against donor Kidney Donor Profile Index (KDPI) - patients with EPTS <20% (longest predicted survival) preferentially receive kidneys with KDPI <20% ("longevity matching") (Goldman-Cecil Medicine, p. 3310-3314; Barash, Cullen & Stoelting's Clinical Anesthesia, p. 481-484).
• Waiting time can start from dialysis initiation or once eGFR <20 mL/min. Median deceased-donor wait time nationally is about 4 years, longer for certain blood types/highly sensitized patients.

• Advantages over deceased donor: elective/scheduled timing, allows preemptive transplantation (before dialysis, improves outcomes), much lower delayed graft function (<5% vs 25% for deceased donor), and superior patient/graft survival (Barash, Cullen & Stoelting's Clinical Anesthesia, p. 490-500).
• Kidney is implanted heterotopically (native kidneys left in place, unlike orthotopic organs such as heart/lung/liver) - Schwartz's Principles of Surgery, p. 2811.

3. Surgical Technique

• Extraperitoneal placement in the iliac fossa via curvilinear (Gibson) incision.
• Renal artery and vein anastomosed end-to-side to the external iliac vessels in adults (occasionally common iliac if atherosclerotic disease present); in children <20 kg or third transplants, an intraperitoneal approach with anastomosis to the aorta/IVC is used.
• Deceased-donor kidneys with multiple arteries may use a Carrel patch of donor aorta.
• Minimizing warm ischemia time at implantation is critical to prevent delayed graft function (Mulholland and Greenfield's Surgery, p. 13-28).

4. Immunosuppression

• Belatacept (costimulation blocker) substituted for a calcineurin inhibitor reduced 7-year risk of death/graft failure by >40% versus cyclosporine in trials, despite more early acute rejection episodes (Goldman-Cecil Medicine, p. 3325).
• HLA matching matters: HLA-identical siblings have the best long-term outcomes; greater HLA mismatch correlates with worse outcomes.

5. Early Post-Transplant Complications

• Defined as need for dialysis in the first post-transplant week; caused mainly by acute tubular necrosis (ATN) from ischemia-reperfusion injury.
• Risk factors: prolonged cold ischemia time, donor age >50, diabetic ESKD, dialysis vintage >5 years, presence of HLA alloantibodies. Risk is reduced with female donor/recipient or when trauma caused donor death.
• Therapeutic hypothermia of the deceased donor reduces DGF incidence (28% vs 39% with normothermia); machine perfusion preservation is another strategy now in routine use at some centers (Comprehensive Clinical Nephrology, p. 618-621).
• DGF is an independent risk factor for interstitial fibrosis and tubular atrophy (IFTA) and for late graft failure, and it can mask concurrent acute rejection - a low threshold for graft biopsy is recommended in DGF patients (Mulholland and Greenfield's Surgery, p. 66; Brenner and Rector's The Kidney, p. 426).

• Renal artery thrombosis: rare (~1%), presents with sudden anuria and rapidly rising creatinine, minimal graft pain; diagnosed by Doppler ultrasound/nuclear scan showing absent flow; usually unsalvageable, requiring nephrectomy.
• Renal vein thrombosis: anuria plus more pronounced pain, swelling, hematuria; risk of graft rupture/hemorrhage; usually requires transplant nephrectomy; anticoagulation if thrombus extends beyond the renal vein (Comprehensive Clinical Nephrology, p. 500-508).
• Acute vascular thrombosis is the most common cause of graft loss in the first week post-transplant.

• Ureteral obstruction/anastomotic leak, evaluated by ultrasound and nuclear renal scans (Tc-99m DTPA or I-131 Hippuran).

6. Rejection

• Banff Classification provides standardized histologic criteria for grading rejection.

7. Other Complications

• Infections: dominant cause of morbidity/mortality; categorized by Rubin as occurring in month 1, months 2-6, and beyond 6 months post-transplant. In some regions infections complicate 50-75% of recipients with mortality 20-60% (Brenner and Rector's The Kidney, p. 3870).
• BK polyomavirus nephropathy: managed by screening for BK viremia and prompt reduction of immunosuppression.
• Malignancy: increased risk of skin cancers and post-transplant lymphoproliferative disorder (PTLD, EBV-driven) due to chronic immunosuppression; treated by reducing immunosuppression plus antiviral therapy.
• Recurrent primary disease in the allograft (e.g., FSGS, IgA nephropathy) is a cause of late graft loss.
• Cardiovascular disease remains the leading cause of death in transplant recipients overall.
• Drug-specific issues: mycophenolate causes diarrhea (worse with tacrolimus); ACE inhibitors/ARBs/NSAIDs risk functional prerenal failure early post-transplant, compounded by calcineurin inhibitor vasoconstriction.

8. Outcomes

• Kidney transplant graft and patient survival substantially exceed those on dialysis.
• Living donor recipients have superior graft survival vs deceased donor recipients.
• As an example from a resource-limited program (Karachi, Pakistan), 1- and 5-year graft survival rates of 92% and 85% were reported, illustrating that good outcomes are achievable even outside high-resource settings (Brenner and Rector's The Kidney, p. 3858).

Quick Comparison: Kidney vs Liver vs Lung Transplant

Recent Evidence Check (PubMed, last 2 years, systematic reviews/meta-analyses)

• Value of protocol biopsy in monitoring transplant outcomes - systematic review/meta-analysis (PMID: 39003205, 2024) - supports biopsy-based surveillance discussed above for detecting subclinical rejection.
• Sex/gender as predictors of allograft and patient outcomes after kidney transplantation - Cochrane systematic review (PMID: 39698949, 2024).
• Antihypertensive treatment for kidney transplant recipients - Cochrane systematic review (PMID: 39082471, 2024) - relevant given post-transplant hypertension management is a common issue not covered in depth above; worth consulting if you want detail on BP drug choice (calcium channel blockers vs ACE-I/ARB) in this population.

Comparative Table: Liver, Kidney, Heart & Lung Transplant

Quick take on procedure/type distinctions

• Liver and lung are true orthotopic replacements of a diseased organ (native organ removed).
• Kidney is unique in being placed heterotopically - the failed native kidneys are usually left in place, and the graft goes into the iliac fossa.
• Heart is almost always orthotopic today, with the bicaval technique now favored over the older biatrial technique because it preserves better sinoatrial node function, reduces atrial arrhythmias, and gives better hemodynamics. Heterotopic ("piggyback") heart transplant is now rare, largely replaced by mechanical circulatory support devices for temporary single-ventricle failure.
• Lung transplant type (single vs bilateral vs heart-lung) is chosen based on the underlying disease - infected native lungs (CF, bronchiectasis) or pulmonary vascular disease mandate bilateral transplant to avoid contaminating or overloading a single new lung.