Lung transplantation for advanced bronchiectasis

Lung transplant (LT) can be successfully performed on patients with advanced bronchiectatic lung disease with subsequent good posttransplant quality of life and long-term outcome. Most of the data are derived from patients with cystic fibrosis (CF), but LT can be effective in patients with non-CF bronchiectasis as well. Despite the presence of chronic lower respiratory tract infection with bacterial pathogens in these patients pretransplant, posttransplant infections do not generally have significant impact on survival, although infection with antibiotic-resistant bacteria may complicate posttransplant management. Although benefit of LT for young children with CF is somewhat controversial, LT can clearly benefit older children and adults with advanced lung disease due to bronchiectasis. This article reviews indications (and contraindications) for LT, discusses particular problems that may arise posttransplant, and provides a rationale for referring patients with bronchiectasis for LT.