Current status of lung transplantation in Korea

Since the first transplantation performed in 1963, lung transplantation (LT) has become the primary treatment for end-stage lung disease. In Korea, the first LT was performed in 1996 and the number of transplants remained constant at approximately 10 cases a year until 2010, when the number of LTs increased rapidly. One of the reasons for this increase was the outbreak of humidifier disinfectant-related acute respiratory distress syndrome in 2011, which became an enormous public health concern in Korea. The Korean Network for Organ Sharing (KONOS), which records all deceased-donor LTs performed in Korea, was founded in 2010 following the enactment of the transplantation law. The statistics of LTs in Korea differ significantly from those of the International Society for Heart and Lung Transplantation (ISHLT). First, the common indications for LTs are different; in Korea, idiopathic pulmonary fibrosis (IPF) is the most common reason for LT. Second, the Korean Lung Allocation Score (LAS) considers only the disease severity of the recipient when prioritizing the recipients; thus, nearly half of the LT recipients require extracorporeal membrane oxygenation (ECMO) or mechanical ventilation support prior to transplantation. Third, because of the low rate of usability of the donor lung and paucity of donors, the waiting period for recipients is increasing. Finally, there is a severe mismatch in the number of LTs performed in different regions of Korea. The postoperative 1-, 3-, and 5-year survival rates according to the KONOS registry are 61.8%, 52.3%, and 45.3%, respectively. These rates are poorer than those published by the ISHLT, possibly because patients with more severe disease undergo LT in Korea. Therefore, the Korean LAS needs to be adjusted to increase the number of LTs in patients with less severe disease, and to improve the overall survival rate of LT recipients.