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Bilateral lung transplantation (BLT) has evolved into a routine procedure and is the most frequently performed method. Traditionally single lung transplantation (SLT) has been the procedure of choice in patients with non-infective end-stage lung disease such as chronic obstructive pulmonary disorder (COPD) and idiopathic pulmonary fibrosis (IPF). Most common incisions for SLT are the posterolateral thoracotomy, anterolateral thoracotomy and median sternotomy, which are usually used if cardiopulmonary bypass (CPB) has to be employed. The preferred surgical incision for BLT is a bilateral transverse thoracotomy joint across the middle, best known as a clamshell incision. Cannulation for CPB is achieved using the ascending aorta and both the inferior vena cava (IVC) and superior vena cava (SVC) with tapes around for sealed occlusion. After intensive animal research and clinical experience gained from kidney and liver donation, the technique of lung donation after cardiac death (DCD) has been established successfully in recent years.
Giorgina Mieli-Vergani, Alex Mowat Professor of Paediatric Hepatology, Department of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital, London, England; Director of the Paediatric Liver Centre, Department of Children's Health, King's College Hospital, London, England,
Diego Vergani, Professor of Liver Immunopathology, Department of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital, London, England
Autoimmune hepatitis (AIH) is a progressive inflammatory liver disorder preferentially affecting females and characterized serologically by high aminotransferase levels, elevated immunoglobulin G (IgG), and presence of autoantibodies and histologically by interface hepatitis in the absence of a known etiology. AIH is divided into two types according to the auto-antibody profile: patients with type 1 are positive for antinuclear antibody (ANA) and/or anti–smooth muscle antibody (ASMA); patients with type 2 are positive for anti–liver-kidney-microsomal antibody type 1 (anti-LKM-1). AIH responds satisfactorily to immunosuppressive treatment.
HISTORY AND EPIDEMIOLOGY
Autoimmune hepatitis is a relatively recently recognized disease, having been first described by Waldenström  in 1950. Seropositivity for ANA, the hallmark of systemic lupus erythematosus, led Mackay et al.  to call it lupoid hepatitis, a term no longer used. Because the disease frequently presents acutely, similarly obsolete is the term chronic active hepatitis, which implied that the disease should be chronic, that is, of at least 6 months' duration, before institution of immunosuppression. Before the efficacy of immunosuppression was established, untreated severe AIH had a mortality rate of 50% at 5 years and 90% at 10 years [3, 4]. The prevalence of AIH is unknown. Studies in adults have reported rates varying from 1 in 200,000 in the U.S. general population  to 20 in 100,000 in females over 14 years of age in Spain ; both figures are probably underestimates.
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