Transplantation pulmonaire et ECMO au cours des pneumopathies interstitielles diffuses

Abstract

Lung transplantation (LTx) is nowadays the only valid therapeutic option which improve significantly survival and quality of life for patients with idiopathic pulmonary fibrosis (IPF). IPF represents nearly 1/4 of the indications of LTx. There was recent published update for the selection of lung transplant candidates, with: specific criteria for indication to transplant and waiting list inscription; it appears l as essential to refer as soon as patient with a diagnosis of IPF to a transplant team. Indeed, late LTx performed in the context of respiratory failure or acute exacerbation of IPF is associated with higher risk of morbidity and mortality posttransplant. The procedure of choice is still debated, with the balance risk/benefit to be discussed in individual cases, according to the presence or not of patient’ comorbidities. However, there was a regular increase in the prevalence of double- LTx (65 %) due to better survival, allograft functional outcome and quality of life post transplant in IPF. Extracorporeal membrane oxygenation (ECMO) devices and techniques are emerging as a bridge to LTx, with encouraging results for patients with respiratory failure despite of invasive ventilation, permitting to save time to transplant candidates in the context of emergency procedure.