Characteristics and Outcomes of 1500 Lung Transplantations in the Leuven Lung Transplant Program: Turning Past Lessons Into Tomorrow's Foundations.

Lung transplantation has become an established life-saving treatment for selected patients with end-stage pulmonary disease. In December 2024, our center reached the milestone of 1,500 lung transplants, providing an opportunity to evaluate long-term trends, outcomes, and challenges. We analyzed donor and recipient demographics, procedural evolution, and graft survival. Contemporary guidelines and consensus recommendations were also reviewed to contextualize current practice and highlight unmet needs. Median graft survival improved markedly across eras: 3.5 years between 1991 and 2000, 9.9 years between 2001 and 2010, and 11.2 years between 2011 and 2020 (p < 0.0001). Shifts in procedure type, donor selection, and transplant indications mirrored broader developments in the field (all p < 0.0001). Donor and recipient age increased significantly over time, with older recipients experiencing poorer long-term outcomes. Despite these advances, chronic lung allograft dysfunction (CLAD) remains the most important barrier to durable success, with median CLAD-free survival of 6.7 years in the modern era (2010-2024) and a retransplantation rate of 4%. While survival now exceeds a decade in many recipients, extended longevity presents new challenges, including management of comorbidities and optimization of CLAD prevention, treatment, and retransplantation strategies. Continued translational research and evidence-based approaches remain critical to improving long-term results.