Objective: Lung transplantation is the definitive treatment for end-stage pulmonary disease, but ongoing challenges remain in long-term survival. We report our single-center experience of 2000 adult lung transplants over a nearly 35-year period and assess trends in patient demographics, intraoperative management, and perioperative and long-term outcomes. Methods: We retrospectively reviewed 2000 lung transplants performed between 1988 and 2023 at our center. Recipients and donors were separated into 3 eras: Era 1 (1988-2000), Era 2 (2001-2011), and Era 3 (2012-2023). Recipient outcomes were compared among the eras. Results: There were differences in recipient demographics across the eras. Over time, we have increasingly performed transplantation in patients with restrictive lung disease. Overall graft survival has improved, with median graft survival increasing from 5.5 years (Era 1) to 9.0 years (Era 3) (P < .0001). We observed similar trends when patients were stratified by transplant indication. The incidence of primary graft dysfunction grade 3 has remained stable at 28.7% in Era 2 and 26.7% in Era 3 (P = .4892). The median freedom from chronic lung allograft dysfunction has improved from 3.2 years (Era 2) to 3.4 years (Era 3) (P = .0001). Conclusions: Lung graft survival has improved over time at our institution due to advances in perioperative and long-term management. However, primary graft dysfunction grade 3 rates have not changed, and chronic lung allograft dysfunction is commonly diagnosed within the first 4 years after transplant. Further research is necessary to understand these disease processes and to generate new treatment strategies to address them.
