Lung Transplantation – All you wanted to know

Lung transplants are performed as a lifesaving treatment for people with end-stage lung disease. A lung transplant is a surgery to remove diseased lungs and replace them with lungs from a healthy donor. There are only a few specialized facilities across the world that perform lung transplants. A patient has to be referred to one of these centers to be considered for the surgery.

What is a Lung Transplant?

Lung Transplantation (also called Pulmonary Transplantation) is a surgical procedure where a patient’s diseased lungs are totally or partially replaced by lungs that come from a donor. Donor lungs can be retrieved from a living donor or a deceased donor. A living donor can donate only one lung lobe. With certain lung diseases, a recipient may need to receive only a single lung. With other lung diseases like cystic fibrosis, it is imperative that a recipient receives both lobes of the lung. While lung transplant carries certain associated risks, they can also extend life expectancy and enhanced quality of life for end-stage lung diseases.

Lung transplant is a very useful treatment for respiratory diseases that have curtailed the lungs function severely. In such patients, a lung transplant can increase longevity and also help improve the quality of life. However, lung transplant is a complex surgery needing cutting edge facility and care.

Once the donor becomes available, he or she will be evaluated by a team of experts. If they pass the criteria set by the expert team, the organ will be accepted for transplantation. Single lung, double lung, or combined heart & lung transplant will be done depending upon the disease of the patient. Immediately after the surgery, the patient will be admitted in a dedicated transplant critical care unit for recovery.

There will be a follow-up care protocol which includes monitoring of the recovery process and identification of infection, rejection, and intolerance to medications.

Who Needs a Lung Transplant?

Patients who are diagnosed with the following diseases need lung transplantation

• Chronic Obstructive Pulmonary Disease (COPD)
• Idiopathic Pulmonary Fibrosis (Decline of Lung Function such as shortness of breath, dry cough, etc.)
• Unable to complete 6min of walk test or less than 300 m covered.
• Cystic Fibrosis (Genetic Disorder resulting in difficulty in breathing, coughing of mucus)
• Idiopathic Pulmonary Hypertension (High Blood Pressure in Lung arteries)
• Bronchiectasis and Sarcoidosis
• Failed Lung Transplant

Despite the severity of a patient’s respiratory condition, certain pre-existing conditions may make a person a poor candidate for Lung Transplantation such as- congestive heart failure, kidney diseases, liver diseases, lung cancer, etc.

What are the requirements of a Potential Donor?

There are certain requirements for potential lung donors whose lung(s) would be suitable to fit into the recipients’ body.  In case of a living donor, the safety of the donor is paramount and every precaution should be taken before considering him/her as a suitable donor. The following individuals would be considered as suitable living donors:

• They should be healthy
• Their lung size should match
• Age should be within the limit criteria
• Their blood groups should match

What are the requirements of potential Recipients?

A lung transplantfacility with its expert team would have their set standard protocols to decide which candidates qualify for Lung Transplant and which do not: The following requirements and parameters could be used to consider an individual as a potential recipient:

• End-Stage Lung Diseases
• No further medical management could be of any help
• No other chronic medical conditions (heart, kidney, liver)
• No current infections o recent cancer
• No HIV or, Hepatitis
• No Alcohol or, Smoking or, Drug Abuse
• Within an acceptable weight range
• Age (Single vs. Double Transplant)
• Acceptable Psychological Profile
• Family Support system
• Financially stable to bear the expenses
• Able to comply with the post-transplant regimen

What medical tests are required for a potential transplant candidate?

Patients who are being considered for placement on an organ transplant list undergo extensive medical tests to evaluate their overall health status and suitability for Lung Transplant Surgery;

• Blood Grouping: The Recipient blood type must match with the donor’s, due to antigens that are present on donated lungs. A mismatch of blood type can lead to a strong response by the immune system and the subsequent rejection of the transplanted organs.
• Tissue Typing: Ideally, the lung tissues would also need to match as closely as possible between the donor and the recipient, but the desire to find a highly compatible donor organ must be balanced against the immediate need of a patient.
• Chest X-ray (PA/LAT): To verify the size of the lungs and chest cavity
• Pulmonary Function Test
• CT Scan(High-resolution Thoracic & Abdominal)
• Bone Mineral Density Scan
• MUGA(Gated Cardiac Blood Pool Scan)
• Cardiac Stress Test (DSA)
• Ventilation/ Perfusion (V/Q) Scan
• Electrocardiogram
• Cardiac Catheterization
• Echocardiogram

Lung Transplant Team

The Transplant team generally includes:

• Transplant Surgeons
• Transplant Pulmonologist
• Transplant Cardiologists
• Intensivists/ Critical Care Specialist
• Infectious Disease Consultants
• Immunologists
• Pathologists
• Transplant Coordinators
• Trained ICU & Ward nurses
• Liaison Officer

What are the types of lung transplant?

There are mainly 4 types of Lungs which are offered to patients depending upon the requirements:

1. Lobe Lung Transplantation: A lobe transplant is a surgery in which part of a living or, deceased donor’s lung is removed and used to replace the recipient’s diseased lung. In the case of a living donor, this procedure needs the donation of lobes from two different individuals, replacing a lung on each side of the recipient.
2. Single Lung Transplantation: Many patients can be helped by the transplantation of a single healthy lung. The donated lung comes typically from a donor who has been pronounced brain dead.
3. Double Lung Transplantation: Certain patients may require both lungs to be replaced. This is especially the case for people with cystic fibrosis, due to bacterial colonization commonly found within such patients” lungs; as one lung could potentially infect the newly transplanted lung.
4. Heart & Lung Transplantation: Some respiratory patients may also have severe cardiac disease which would necessitate a heart transplant. Such patients can be treated by a surgery where both lungs and the heart are replaced by organs from a single donor or donors.

Conclusion    

Since it’s first successful performance 30-years ago, lung transplantation has become an accepted treatment procedure for end-stage lung diseases such as fibrosing alveolitis, emphysema, cystic fibrosis, bronchiectasis, and pulmonary hypertension. Outcomes are getting better because of developments in surgery, patient selection, and management, as well as the availability of potent immunosuppressive agents.