Definition and Overview

A lung transplant is a major surgical procedure that replaces a diseased lung with a healthy lung either from a deceased or live donor. Depending on the patient’s condition or official diagnosis, the transplant may be single (only one of the lungs is replaced), double, or it could involve the heart.

Patients who require new lungs are placed on an active list and are notified once suitable donor lungs become available. It is important to note that only those patients whose conditions are considered severe as included in the list. Those whose conditions are not deemed serious enough to warrant a lung transplant are placed on other less invasive treatments.

Who Should Undergo and Expected Results

A lung transplant is often carried out on patients diagnosed with:

  • Chronic obstructive pulmonary disease (COPD), which is a serious progressive condition, in which the damage is mostly caused by smoking
  • Pulmonary hypertension or high blood pressure in the vessels that transport blood between the lungs and the heart
  • Scarring of the lungs
  • Cystic fibrosis, a hereditary disease characterised by the excessive buildup of mucus in the lining of the lungs, reducing the organ’s capacity to receive oxygen
    Although lungs can be obtained from living donors, the number of donated lungs is still severely limited. Also, it usually takes two living donors for one recipient to perform a double lung transplant. For this reason, hospital programs implement rigid guidelines for candidates. Those who have a bigger chance of surviving the procedure and a more positive outlook are prioritised. Smokers are almost always denied of transplant, as well as those who are grossly under or overweight.

When it comes to prognosis, most transplant patients live for at least a year while some live between 5 and 20 years after transplant.

How Does the Procedure Work?

The transplant begins with a comprehensive assessment to ensure the patient is a good candidate for the procedure and that the right match can be found. Whether the donor is deceased or living, it’s essential that he shares the same blood type and organ size with the patient.

As part of the evaluation, the surgeon reviews the patient’s medical records and recommends a variety of tests that include chest X-ray, MRI scan, and angiogram, an imaging examination that helps the surgeon assess the flow of blood in the lungs’ blood vessels. An echocardiogram (ECG) is also necessary to assess the heart’s electrical activity as the blood also moves from the heart to the lungs and vice versa.

If the surgeon has determined the patient is a match, he proceeds by assembling his team of specialists, which include an anaesthesiologist, pulmonologists, and infectious disease doctors. Unless the patient already has a matched living donor, who is usually an immediate relative, the patient is referred to a transplant coordinator who helps the patient search for the right donor.

During the actual procedure, general anaesthesia is administered while the patient is either lying on the side (if only one lung is to be removed) or flat on the back (if it’s a double-lung transplant). The patient’s vital signs are closely monitored, and the area to be incised is applied with antiseptic. If only one of the lungs is to be replaced, the incision is made on the side of the diseased lung. Otherwise, a horizontal incision is made underneath the breast area. The lung is then removed and replaced with a new one, ensuring that all the tubes and vessels are connected properly. The incisions are then closed and the tubes are attached to help the new lungs work properly.

The operation can take up to 12 hours while complete recovery can take around three months.

Possible Risks and Complications

Patients who undergo lung transplant are at risk of:

  • Infection
  • Bleeding
  • Perforation of the lungs
  • Certain types of cancer like lymphoma or breast cancer
  • Blood clot
  • Organ rejection
  • Blockage of the vessel or airway

References:

  • Kotloff RM, Keshavjee S. Lung transplantation. In: Broaddus VC, Mason RJ, Ernst MD, et al. Murray & Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 106.

  • Putnam JB. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 58.

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