Lung Transplant
A lung transplant is a surgical procedure for treating advanced forms of lung disease that no longer respond to other treatments. A lung transplant involves partially or completely removing a patient's diseased lung, and replacing it with a healthy lung from a human donor. Sometimes, a patient receives a double-lung transplant. Healthy lungs can come from donors who are younger than 65, or brain dead but still on life support or, in cases of double-lung transplants, from two living donors, each of whom contributes one lung.
Reasons for Lung Transplant
A lung transplant is a last resort for a patient with a life-threatening lung disease who is considered unlikely to survive more than a year or two without the transplant. Reasons a lung transplant may be necessary include the following:
- Congenital lung defect
- Cystic fibrosis
- Emphysema or other forms of COPD
- Interstitial lung disease
- Pulmonary hypertension
- Sarcoidosis
- Pulmonary fibrosis
Even for a patient desperately in need of a lung transplant, there is a waiting list for donor lungs. Frequently, a patient waits 2 to 3 years to get to the top of the list. In certain cases, a lung transplant may be contraindicated because the patient is considered too old, infirm or malnourished to undergo or benefit from the transplant.
Preparation for Lung Transplant
Before a lung transplant can be performed, several tests must be administered to type the patient's blood and tissue, evaluate heart and lung function, and make sure the patient is free of infection or cancer. These tests help to ensure that the patient's body is healthy enough for the transplant, and that the transplanted tissue will not be rejected. Once qualified for a lung transplant, the patient is put on a waiting list prioritized by the severity of the lung disease, and the likelihood that the transplant will be successful. A patient toward the top of the waiting list must be ready to go to the hospital for surgery on an immediate basis.
The Lung Transplant Procedure
The procedure is conducted under general anesthesia through a surgical cut in the chest. A heart-lung machine is used during the operation, so that the patient's body continues to function while the heart is stopped.
During a single-lung transplant, the incision is made on the side of the chest from which the damaged lung will be removed. Surgery usually takes between 4 and 8 hours. During a double-lung transplant, the incision is made across the chest, below the breasts; surgery usually takes between 6 and 12 hours. When a double-lung transplant is performed, the first lung transplant is completed before the second one begins. At times, heart and lung transplants are performed during the same operation.
Whether the operation involves a single- or double-lung transplant, the major blood vessels and air passages of the new lung(s) are stitched to the patient's existing blood vessels and airways. Once the donor organ is sutured in place, chest tubes are inserted for drainage of excess air, blood and other fluids. These tubes remain in place until the new lung(s) expand completely.
Risks of Lung Transplant
There are serious risks to a lung transplant, but it is only performed when a patient will die without one, making the risks worthwhile. Risks of a lung transplant include the following:
- Blood clots
- Postsurgical infection
- Rejection of new lung tissue
- Development of certain cancers
- Difficulties at blood-vessel and airway connection sites
The immunosuppression medications administered on an ongoing basis after a lung transplant carry their own risks, which include the following:
- Diabetes, high cholesterol or osteoporosis
- Increased risk of infection
- Damage to other organs
A patient is at greatest risk immediately after surgery, and for the first year after the transplant.
Recovery from Lung Transplant
Immediately after the procedure, a patient is in intensive care, and on a ventilator for several hours for up to several days, and remains hospitalized for 1 to 4 weeks. Full recovery from a lung transplant typically takes about 6 months, but the patient has to be closely monitored for the remainder of his or her life.
Although life expectancy after a lung transplant is shorter than normal, the patient is expected to have greater longevity than she or he would have had without one, and to have a greatly improved quality of life.