Abstract
Most studies reported from the world's high-volume centers demonstrated encouraging short- and long-term outcomes after extended criteria lung transplantations. Pushing the limit of donor selection is worth the effort in the current situation of a huge organ demand-supply gap. However, sensible risk-oriented management should be undertaken to alleviate the negative influence of donor lung qualities and to a secure feasible survival outcome in an extended criteria lung transplantation. The key factors to success include a best donor-recipient risk matching, surgery with minimal dependence on heart lung apparatus, and posttransplant recipient management with maximal care of protecting allograft from oedema. The current lung selection criteria can be safely relaxed on a case-by-case basis only if donor risk factors are accurately and specifically identified and the recipient is managed appropriately to be prepared to recondition extended lungs in the body after transplantation.
