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July 15, 1992

Pulmonary Medicine

JAMA. 1992;268(3):405-407. doi:10.1001/jama.1992.03490030117052

In the last few years, there have been significant changes in our understanding of the pathophysiology and approach to treatment of a number of pulmonary disorders. In 1981, heart-lung transplantation was introduced as the first truly viable option for the long-term treatment of pulmonary hypertension secondary to primary pulmonary hypertension and Eisenmenger's syndrome. In the short time since then, breakthroughs in surgical techniques and the availability of cyclosporine have permitted a number of new transplantation techniques, including single-lung, double-lung, and now bilateral sequential lung transplants.

Single-lung replacement initially was recommended only for patients with end-stage interstitial lung disease. The transplant procedure improved overall function, and the use of only one lung simplified the surgical technique compared with heart-lung transplantation, lowering the perioperative morbidity and mortality and increasing the number of organs available for transplantation.

Initially, it was thought that a single-lung transplant would be inappropriate for patients with associated cor