74. Lung Transplantation with Dr Lara Jones and Dr Jason Gauthier

Lung transplantation presents unique clinical challenges due to the organ's constant exposure to environmental pathogens and its high immunogenicity, resulting in a median survival of approximately seven years. Managing these patients requires a multidisciplinary approach, particularly when critical illness necessitates bridging strategies like ECMO. While ECMO can serve as a vital bridge to transplant, clinicians must establish clear, time-limited goals to avoid non-beneficial care and the "frailty cascade" that often leads to delisting. Key perioperative considerations include minimizing sedation to facilitate early mobility, managing complex immunosuppression regimens, and addressing foregut pathology to mitigate chronic rejection risks. Because lung transplant recipients face lifelong susceptibility to infections and graft dysfunction, meticulous attention to detail—ranging from ventilator settings to the avoidance of sensitizing blood products—remains essential for optimizing long-term outcomes and preserving allograft function.