Lung versus heart-lung transplantation for cystic fibrosis: is the debate still open?

A lthough medical management has considerably improved, cystic fibrosis (CF) remains a major cause of mortality from suppurative lung disease, in children and young adults. Lung transplantation is currently the only available efficient treatment of the life-limiting aspects of the condition to achieve improved quality of life and long-term survival in these patients, who stand to benefit more from transplantation than any other diagnostic group [1]. In this issue of the European Respiratory Journal, GANESH et al. [2] present the results of the UK Cardiothoracic Transplant Audit, with similar outcomes achieved by heart–lung transplantation (HLT) and bilateral lung transplantation (BLT) in CF recipients, thereby reopening a debate that was considered closed for a while. Indeed, very few HLTs are still performed for this indication, and the main reason for this is the trend for fewer HLT procedures being performed worldwide, which is reflected again in the international figures from last year’s results of the Registry of the International Society of Heart and Lung Transplantation [3]. Since ,50% of CF patients die on the waiting list due to a scarcity in the supply of donor thoracic organs, current efforts involve any attempt to expand the lung donor pool: specifically, liberalisation of donor criteria [4] and the use of non-heart-beating donors for adult recipients [5], lung bipartitioning and lobar transplantation [6], as well as living-lung donor transplantation for paediatric recipients [7].