Lung transplantation - surgical procedure and complications

Lung transplantation - surgical procedure and complications

Lung Transplantation is an OPERATION to replace an individual’s diseased lung with a healthy donor lung. Doctors performed the first successful lung transplantation in 1983 and now perform several hundred lung transplantations each year. A lung transplantation may involve one lung or both LUNGS. Less commonly a lung transplantation includes both lungs and the HEART, such as to treat primary PULMONARY HYPERTENSION with HEART FAILURE.

Donor lungs come primarily from people who donate their organs upon death. Live lobular donation, in which a living donor undergoes surgery to have a lobe of the lung removed for transplantation (lobectomy), is occasionally a viable option for people who can find a tissue match among two prospective donors (usually family members) willing and medically capable of donating a healthy lung lobe (live lobular donation typically requires two lobes). Doctors most commonly consider living lobular donation as an option for children who have aggressive CYSTIC FIBROSIS.

Many circumstances influence whether an individual is an appropriate candidate for lung transplantation. Because donor lungs are in short supply, the criteria for transplantation are stringent though vary somewhat among transplant centers. In general, lung transplantation recipients must be under age 65, in good health except for their pulmonary conditions, and demonstrate willingness and ability to comply with the post-transplantation care regimen. Transplantation criteria nearly always exclude people who have cancer (lung or other), immunodeficiency disorders, active TUBERCULOSIS, neurologic or neuromuscular disorders, LIVER disease, or renal (kidney) disease.

CONDITIONS FOR WHICH LUNG TRANSPLANTATION IS AN OPTION
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) CYSTIC FIBROSIS
primaryPULMONARY HYPERTENSION BRONCHIECTASIS
bronchiolitis alpha-1-antitrypsin deficiency
PULMONARY FIBROSIS SARCOIDOSIS

Lung Transplantation - Surgical Procedure

The operation for performing a lung transplantation is a THORACOTOMY, done with the person under general ANESTHESIA. The surgery generally takes three to six hours to complete. Typically one surgical team removes and prepares the donor lung and another surgical team removes the diseased lung from the person receiving the lung transplantation. A donor lung remains viable for only four to six hours. Most people are on CARDIOPULMONARY BYPASS during the surgery, though advances in surgical techniques are reducing the need for this. MECHANICAL VENTILATION during recovery and for up to 72 hours after surgery is common. A lung transplant recipient typically stays about 10 days in the hospital after the surgery, the first three to five of them in the intensive care unit (ICU). Recuperation and return to daily activities takes about three to five months for most people.

Risks and Complications

The most significant risk of lung transplantation is rejection of the transplanted lung. This risk is highest during the first four weeks after the surgery and remains a perpetual threat. The risk of death, usually resulting from acute organ rejection, is highest during the first year after the transplant. People who receive organ transplants must take IMMUNOSUPPRESSIVE THERAPY for the remainder of their lives. These medications block the IMMUNE SYSTEM from perceiving the transplanted organ as foreign and attacking it. Immunosuppressive therapy increases the risk for INFECTION. Infections such as INFLUENZA or PNEUMONIA can be life-threatening for people with organ transplants; most transplant programs require organ recipients to agree to receive annual immunizations to help protect against these infections among their criteria for accepting recipients. Long-term immunosuppression carries numerous risks, including a significantly increased likelihood for developing LYMPHOMA, a cancer of the LYMPH structures.

A major complication that affects up to 50 percent of lung transplant recipients is bronchiolitis obliterans, a condition in which the bronchioles (the smallest airways in the lungs) become inflamed and then fibrotic. The fibrotic (SCAR) tissue blocks the narrow openings of the bronchioles, preventing air from reaching the alveoli. As greater numbers of bronchioles become involved, pulmonary function deteriorates. Bronchiolitis is itself an indication for lung transplantation. CORTICOSTEROID MEDICATIONS can help limit the INFLAMMATION though cannot prevent the condition from developing or progressing.

Outlook and Lifestyle Modifications

Most people who receive transplanted lungs can return to many of their regular activities, including physical exercise, with few restrictions unless complications develop. It is important to avoid cigarette smoke and other substances that may irritate or inflame the lungs, and to minimize exposure to other people who have viral or bacterial infections such as sore throats and other common illnesses. Lung transplantation requires regular medical care for follow-up and evaluation of pulmonary function and lung health, with immediate treatment for potential problems and complications. About 45 percent of people who undergo lung transplantation live five years or longer with their donor lungs.

See also HEART TRANSPLANTATION; ORGAN TRANSPLANTATION; SURGERY BENEFIT AND RISK ASSESSMENT.

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The Pulmonary System

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