Lung transplantation is an accepted therapeutic intervention for patients with pulmonary arterial hypertension (PAH) who fail medical therapy. Highly selected candidates with PAH may enjoy improved survival by combining medical therapy with transplantation. Despite the known benefits of lung transplantation that include improvement in haemodynamics, exercise tolerance, shortness of breath and long-term survival, this intervention is associated with significant shortcomings. These include, the need for lifelong immunosuppression, and the morbidity associated with the increased risk for infection and allograft rejection. To maximise the potential outcomes of lung transplantation, candidates should be selected based on the international guidelines developed by a consensus panel of experts in the field (J Heart Lung Transplant, 25, 2006, 745). Early referral to a centre with expertise in the management of PAH and transplantation increases the chances of achieving the best possible long-term outcome for patients with this devastating disease.
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