Contemporary Lung Transplantation

Lung transplantation is a successful therapeutic option for patients with end-stage respiratory failure. Although the clinical outcomes of this procedure have been constantly improving, the care of patients undergoing lung transplantation is still a striking challenge for the entire team involved in the process. The complexity of a clinical lung transplant program requires a trained, multi-specialist team and continuing technical update. Technology provides exciting new opportunities for the improvement of clinical outcomes. 

This text provides a comprehensive, practical and up-to-date insight into clinical lung transplantation. It moves along the pre-, intra-, and post-operative phases of transplantation. It explores the most relevant surgical, medical and immunological concepts of this field. The content focuses not only on the technical, scientific and medical aspects of lung transplantation, but also on the administrative, regulatory and nursing topics of running a lung transplant program. Rather than presenting purely theoretical chapters, the text sets the focus on clinical dilemmas and practical issues involving all the professionals who actively run a lung transplant program.

The reader will be able to access the book for reference on any topic related to clinical care in lung transplantation. This text is intended as a practical resource for surgeons, physicians and health professionals involved in lung transplantation or in setting up a lung transplant program. All chapters are written by experts in their fields and will include the most up to date scientific and clinical information. The overall intent of this publication is to assist the health care provider in all the daily aspects of lung transplantation and to offer a modern, practical source of suggestions and answers. 

Building a Lung Transplant Program.- The Medical Challenge of Lung Transplantation.- Lung Transplantation: A Job Not Only for Doctors.- Psychological Aspects of Lung Transplantation.- Ethical and Medical-Legal Aspects of Lung Transplant.- A Modern View of Transplant Immunology and Immunosuppression.- Lung Transplantation for Cystic Fibrosis.- Lung Transplantation for Restrictive Lung Disease.- Lung Transplantation for Pulmonary Hypertension.- Lung Transplantation for COPD.- Lung Transplantation for Connective Tissue Disorders.- Lung Transplantation for Rare Indications.- Pediatric Lung Transplantation.- Dealing with Difficult Bugs Before Lung Transplantation.- Assessment, Procurement, and Preservation of the Lungs.- Using Hepatitis C-Positive Donors and Other High-Risk Donors.- Choosing the Right Patient for Lung Transplantation: Assessment of Histocompatibility and Sensitization Status.- Ex Vivo Lung Perfusion: Promises and Reality.- Donation of the Lungs After Circulatory Death.- Artificial Bridge to Lung Transplantation.- Technique and Controversies of Single-Lung Transplantation.- Volume Reduction Techniques of the Graft and Reduced Size Transplantation.- Technique and Controversies of Heart-Lung Transplantation.- Retransplantation of the Lung(s).- Technique and Controversies of Pediatric Lung Transplantation.- What Kind of Extracorporeal Support Should I Use During Lung Transplantation?.- Living-Donor Lung Transplantation: Indications and Limitations.- Rounding in the Intensive Care Unit after Lung Transplantation.- Use of Extracorporeal Membrane Oxygenation (ECMO) After Surgery: Management of Primary.- Graft Dysfunction (PGD).- Surgical Complications of Lung Transplantation.- Dealing with Fungal Infections After Lung Transplantation.- Esophageal Disease and Lung Transplantation: A Difficult Challenge.- Large Airway Disease After Transplantation.- The Complex Spectrum of Chronic Allograft Rejection.- Sustainability of Lung Transplantation.- Choice of Medications for Lung Transplantation.- Building Basic and Clinical Research Around Lung Transplantation.- Data Collection and Quality Control: The Role of Scientific Societies, OPOs, and Governmental .- Agencies.- Clinical Trials in Lung Transplantation.- Long-Term Artificial Lung Support: Will We Get There?.

Dr. Alessandro Bertani

Dr. Bertani, born April 23rd, 1973, is a graduate of the University of Pavia School of Medicine in 1998. After completing his general surgery residency at the Department of General Surgery, Liver and Lung Transplantation in Bergamo (Italy), he trained as a clinical fellow in cardiothoracic transplant surgery (2002-2003) and Minimally Invasive Thoracic Surgery (2003-2004) at the University of Pittsburgh (USA). He also trained as a clinical fellow in Cardiothoracic Surgery (2005-2006) at ISMETT-UPMC Italy, Palermo. In 2006 he completed a PhD in Experimental Surgery and Microsurgery at the University of Pavia School of Medicine. He holds national boards in general surgery and thoracic surgery.

After joining ISMETT as an attending thoracic surgeon in 2007, Dr. Bertani was appointed in 2011 as the Chief of Thoracic Surgery and Lung Transplantation. In March 2023 he founded and was appointed as the Director of the Chest Center at ISMETT, a multidisciplinary Department focusing on lung, mediastinal and esophageal disease. He also is a Clinical Assistant Professor of Surgery at the University of Pittsburgh, and the Director of the ISMETT pre-clinical research laboratories in Palermo.

He performed more than 3000 general and thoracic surgery operations, including oncologic and benign, open and minimally invasive pulmonary, mediastinal and esophageal cases. He performed more than 1000 airway and gastrointestinal endoscopic procedures, including endoscopic ultrasound and interventional endoscopy. He trained many junior surgeons to perform independently thoracic surgery and lung transplant procedures.

Since 2005, Dr. Bertani contributed to the development of the lung transplant program at ISMETT that grew as one of Italy’s busiest programs performing approximately 15 cases/year, including cadaveric, lobar, adult, pediatric transplants and extra-corporeal supports. In 2006 Dr. Bertani performed the first case of lung transplantation in the world in an HIV-positive patient.

The clinical activity of Dr. Bertani also includes an active contribution to the development of lung transplant and thoracic surgery international activities for UPMC.

He is a member of several international medical societies including the Society of Thoracic Surgeons (STS), the European Society of Thoracic Surgeons (ESTS), the International Society for Heart and Lung Transplantation (ISHLT) and the European Society for Cardio-Thoracic Surgery (EACTS) and serves for several national scientific boards and committees. As a visiting professor, he joined different lung transplant and thoracic surgery centers worldwide. Dr. Bertani also sits on the board of directors of the European Society of Thoracic Surgeons (ESTS) and of the Italian VATS Group. As of 2024, he is the Director of Education of the ESTS.

Dr. Bertani acts as principal investigators for several research projects in the field of thoracic surgery and transplantation, both clinical and pre-clinical, which are mostly focused on lung cancer, minimally invasive surgery, organ preservation and clinical lung transplantation.

Dr. Patrizio Vitulo

Dr. Vitulo is a graduate of the University of Pavia School of Medicine in 1987. After completing his residency in Pulmonology at the Department of Respiratory Medicine of the San Matteo Hospital in Pavia, he trained as clinical fellow in the same hospital (Division on Pulmonology and Division of Cardiac Surgery) and in 1992 he became attending pulmonologist. He participated in the foundation of the Pavia Lung Transplant Program in 1991 and in 1992 was appointed as reference pulmonologist for lung transplantation at the same institution. In 2002 he was appointed Medical Director of the Pavia Lung Transplant Program.

He joined ISMETT (Mediterranean Institute for Transplants and Highly Specialized Therapies), Palermo, in 2005 as Head of Pulmonology Service, where he participated in the foundation of the first Lung Transplant Program in Southern Italy. He founded the Sicilian Regional Reference Center for Rare Pulmonary Diseases at ISMETT, particularly involved in pulmonary hypertension and interstitial lung diseases. In 2021 he founded and directed the first Phase 1 Clinical Trial Unit in Sicily.

He has trained junior pulmonologists to perform interventional bronchoscopy and transplant medicine. He is the Medical Director of the Respiratory Therapy Unit at ISMETT.

He is participating in several clinical trials in the field of rare lung diseases as principal investigator.

He is a member of international medical societies such as the European Respiratory Society, Pulmonary Vascular Research Institute, Italian Society of Pneumology and served as member of working groups in these organizations. He is co-founder of the Italian Network for Pulmonary Hypertension (IPHNET) an