Alternative options to increase available tissue for lung transplantation are necessary to close the gap on this unmet clinical need. Transplant efficacy remains a significant clinical issue as transplant rejection rates are high and complications can arise due to the required immunosuppressive drugs 5-year survival is only 50%. Approximately 2000 lung transplants occur annually in Europe, with the same number or more patients awaiting transplantation. Currently, the only option for end-stage respiratory disease is lung transplantation. The overall cost of respiratory disease in the European Union amounts to more than EUR380 billion annually. Respiratory diseases are the third leading cause of death worldwide and are predicted to continue to increase over the coming years. This review aims to present the current state-of-the-art progress for each of these areas and to discuss promising new ideas within the field of lung bioengineering. Concomitantly, there have been exciting efforts in designing bioreactors that allow for appropriate cell seeding and development of functional lung tissue over time. Recently, there have been significant efforts to scale-up cell culture methods to generate adequate cell numbers for human-scale bioengineering approaches. Both biologically derived and manufactured scaffolds seeded with cells and grown ex vivo have been explored in pre-clinical studies, with the eventual goal of generating functional pulmonary tissue for transplantation. A growing number of tissue engineering approaches are exploring the potential to generate lung tissue ex vivo for transplantation. Alternative options to increase tissue availability for lung transplantation are urgently required to close the gap on this unmet clinical need. The only option at end-stage disease is lung transplantation, but there are not enough donor lungs to meet clinical demand.
Chronic respiratory diseases remain a major cause of morbidity and mortality worldwide.
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