Lung Transplant

Overview

Lung transplantation refers to a surgical procedure that replaces a nonfunctional one with a functional one. It replaces the failed or diseased lung with a new one from the donor. This procedure is recommended for those who have tried medications but could not have successful results. 

Lung transplantation can replace either one or both lungs depending on the damage and the condition of the lungs. The donor is generally a deceased one, and transplantation can sometimes be done along with the heart. Lung transplantation can significantly improve the health and quality of life. 

Indications

A lung transplant is indicated when the damaged or unhealthy lungs make breathing difficult, and medications can no longer improve the conditions of the lungs. Conditions like chronic obstructive pulmonary disease with severe flareups in a year associated with severe respiratory failure are indicated for lung transplant. 

Cystic fibrosis associated with severe respiratory failure, along with frequent hospitalizations or a rapid decline in lung function, decreased oxygen levels, and increased carbon dioxide levels, are considered for lung transplant. 

Another lung disease called interstitial lung disease, which is associated with severe flareups or frequent hospitalization due to respiratory decline or severe hypertension, is considered for a lung transplant. 

Conditions of the lungs like bronchiectasis, sarcoidosis, constrictive bronchiolitis, connective tissue diseases, and pulmonary hypertension secondary to congenital cardiac conditions are all indicated for lung transplant as they cause severe breathing difficulties leading to life-threatening situations.

Contraindications for Lung Transplant

Certain conditions that make an individual ineligible for a lung transplant include the presence of active infection, a recent history of lung cancer, life-threatening kidney, liver, or heart diseases, severe heart failure, medical instability due to infections or heart failure, uncontrollable bleeding disorder, active tuberculous infections, severe obesity, significant chest wall deformity. These conditions are not indicated for a lung transplant. 

Before Lung Transplant

A lung transplant is done in a transplant centre. Before the transplant, the individual is evaluated for the surgery by some blood tests, physical examinations, imaging studies, psychological evaluation, and any other necessary tests. The history of previous illnesses, surgeries, medicines taken, and allergies should be shared with the concerned healthcare professional. 

Based on the test results and evaluation, one will be informed if they can be taken for a lung transplant. Sometimes, certain medications, like blood thinners and over-the-counter medications, need to be stopped. Other drugs may be prescribed before surgery. Dietary modifications will be made before surgery.

Matching a donor for transplantation is also very important for a lung transplant. Individuals will be kept on the waiting list for deceased donors. Lung allocation scoring is used to prioritize the patients based on medical urgency and the chance of benefiting from lung transplantation. 

Deceased donors are considered for lung transplantation. Deceased donors who are brain-dead or circulatory dead are taken for a lung transplant. Donors will also be evaluated and subjected to specific tests to check for compatibility. 

These tests include blood typing (to check if the blood groups of donors as well as recipient are suitable), tissue typing (to check if the transplanted tissue will last for a long time in the recipient's body), crossmatch (to check if antibodies of the recipient will reject the donor tissue). 

The donor is evaluated for the cause of death, and their lung is checked for functional capability.  

Other factors, such as the lung size compared with the chest cavity, the distance between the donor organ and the transplant, the condition of the recipient's lung diseases, and overall health, will be assessed. 

An individual must be active and healthy for a successful lung transplant. Taking the prescribed medications on time, eating regularly, exercising regularly, and relaxing can keep one healthy and fasten recovery after surgery. 

During the Transplant

A lung transplant is done under general anaesthesia. Tubes will be placed in the airway and neck to help with breathing. The heart will be continuously monitored. Some tubes are placed in the groin area for blood circulation. 

The recipient's body is disinfected from head to toe with an antiseptic solution during the surgery. Incisions or cuts are made on the chest based on the number of lung transplants. The diseased lung or both lungs are removed, and the new lung is replaced; blood vessels and other necessary connections are made between the recipient's body and the donor's lung. 

This entire setup is sometimes connected to a heart-lung machine until the new lung can work effectively. 

After the Transplant 

An individual is continuously monitored till the vitals stabilize and is awake. A mechanical ventilator assists with respiration, and the tubes in the body help drain fluids from the lungs. Medications are given to prevent rejection of the donor's lung and reduce infection in the body. After being monitored for a few days, the individual is discharged from the hospital as the condition improves. 

Recovery from Lung Transplant 

An individual may require about three months of frequent monitoring after a lung transplant. During the follow-up visits, one must undergo frequent blood tests, chest X-rays, an electrocardiogram, and lung function tests to monitor the functioning of the lung and any signs and symptoms of rejection. A lung biopsy may also be needed to monitor for any rejection of the tissues. 

Risks and Complications

Specific risks and complications are associated with lung transplants, mainly the risk of rejection. Rejection of the tissues is high immediately after the transplant and reduces over a period. This can be reduced by using anti-suppressant medications. The immunosuppressant drugs used for rejection may, in turn, cause issues like disturbances in bone metabolism, diabetes, kidney issues, high blood pressure, and stomach issues. 

The risk of infection is another major complication prevented by medications, washing hands regularly, avoiding pets, and protecting the skin. 

Conclusion

Lung transplantation refers to a life-saving procedure for individuals with end-stage lung disease, offering hope for improved quality of life. Despite the risks and careful post-operative management, including lifelong medication and monitoring, it can significantly enhance respiratory function and overall well-being. It can prolong the survival chances of individuals suffering from lung failure.