lung transplantation


Also found in: Dictionary, Thesaurus, Legal, Acronyms, Encyclopedia, Wikipedia.

Lung Transplantation

 

Definition

Lung transplantation involves removal of one or both diseased lungs from a patient and the replacement of the lungs with healthy organs from a donor. Lung transplantation may refer to single, double, or even heart-lung transplantation.

Purpose

The purpose of lung transplantation is to replace a lung that no longer functions, or is cancerous, with a healthy lung. In order to qualify for lung transplantation, a patient must suffer from severe lung disease which limits activities of daily living. There should be potential for rehabilitated breathing function. Attempts at other medical treatments should be exhausted before transplantion is considered. Many candidates for this procedure have end-stage fibrotic lung disease, are dependent on oxygen therapy, and are likely to die of their disease in 12-18 months.
Patients with emphysema or chronic obstructive pulmonary disease (COPD) should be under 60 years of age, have a life expectancy without transplantation of two years or less, progressive deterioration, and emotional stability in order to be considered for lung transplantation. Young patients with end-stage silicosis (a progressive lung disease) may be candidates for lung or heart-lung transplantation. Patients with Stage III or Stage IV sarcoidosis (a chronic lung
National Transplant Waiting List By Organ Type (June 2000)
Organ Needed Number Waiting
Kidney 48,349
Liver 15,987
Heart 4,139
Lung 3,695
Kidney-Pancreas 2,437
Pancreas 942
Heart-Lung 212
Intestine 137
disease) with cor pulmonale should be considered as early as possible for lung transplantation. Other indicators of lung transplantation include pulmonary vascular disease and chronic pulmonary infection.

Precautions

Patients who have diseases or conditions which may make them more susceptible to organ rejection should not receive a lung transplant. This includes patients who are acutely ill and unstable; who have uncontrolled or untreatable pulmonary infection; significant dysfunction of other organs, particularly the liver, kidney, or central nervous system; and those with significant coronary disease or left ventricular dysfunction. Patients who actively smoke cigarettes or are dependent on drugs or alcohol may not be selected. There are a variety of protocols that are used to determine if a patient will be placed on a transplant recipient list, and criteria may vary depending on location.

Description

Once a patient has been selected as a possible organ recipient, the process of waiting for a donor organ match begins. The donor organ must meet clear requirements for tissue match in order to reduce the chance of organ rejection. It is estimated that it takes an average of one to two years to receive a suitable donor lung, and the wait is made less predictable by the necessity for tissue match. Patients on a recipient list must be available and ready to come to the hospital immediately when a donor match is found, since the life of the lungs outside the body is brief.
Single lung transplantation is performed via a standard thoracotomy (incision in the chest wall) with the patient under general anesthesia. Cardiopulmonary bypass (diversion of blood flow from the heart) is not always necessary for a single lung transplant. If bypass is necessary, it involves re-routing of the blood through tubes to a heart-lung bypass machine. Double lung transplantation involves implanting the lungs as two separate lungs, and cardiopulmonary bypass is usually required. The patient's lung or lungs are removed and the donor lungs are stitched into place. Drainage tubes are inserted into the chest area to help drain fluid, blood, and air out of the chest. They may remain in place for several days. Transplantation requires a long hospital stay and recovery can last up to six months.
Heart-lung transplants always require the use of cardiopulmonary bypass. An incision is made through the middle of the sternum. The heart, lung, and supporting structures are transplanted into the recipient at the same time.

Preparation

In addition to tests and criteria for selection as a candidate for transplantation, patients will be prepared by discussing the procedure, risks, and expected prognosis at length with their doctor. Patients should continue to follow all therapies and medications for treatment of the underlying disease unless otherwise instructed by their physician. Since lung transplantation takes place under general anesthesia, normal surgical and anesthesia preparation should be taken when possible. These include no food or drink from midnight before the surgery, discussion of current medications with the physician, and informing the physician of any changes in condition while on the recipient waiting list.

Aftercare

Careful monitoring will take place in a recovery room immediately following the surgery and in the patient's hospital room. Patients must take immunosuppression, or anti-rejection, drugs to reduce the risk of rejection of the transplanted organ. The body considers the new organ an invader and will fight its presence. The anti-rejection drugs lower the body's immune function in order to improve acceptance of the new organs. This also makes the patient more susceptible to infection.
Frequent check-ups with a physician, including x ray and blood tests, will be necessary following surgery, probably for a period of several years.

Risks

Lung transplantation is a complicated and risky procedure, partly because of the organs and systems involved, and also because of the risk of rejection by the recipient's body. Acute rejection most often occurs within the first four months following surgery, but may occur years later. Infection is a substantial risk for organ recipients. An early complication of the surgery can be poor healing of the bronchial and tracheal openings created during the surgery. A late complication and risk is chronic rejection. This can result in inflammation of the bronchial tubes or in late infection from the prolonged use of immunosuppressant drugs to fight rejection. Overall, lung transplant recipients have demonstrated average one and two-year survival rates of more than 70%.

Normal results

The outcome of lung transplantation can be measured in survival rates, and also in improved quality of life for recipients. Studies have reported improved quality of life after lung and heart-lung transplants. One study showed that at the two-year follow-up period, 86% of studied recipients reported no limitation to their activity. Demonstration of normal results for patients may include quality of life measurements, as well as testing to ensure lack of infection and rejection.

Key terms

Pulmonary — Refers to the respiratory system, or breathing function and system.
Sarcoidosis — A chronic disease with unknown cause that involves formation of nodules in bones, skin, lymph nodes, and lungs.
Silicosis — A progressive disease that results in impairment of lung function and is caused by inhalation of dust containing silica.

Resources

Organizations

Children's Organ Transplant Association, Inc. 2501 COTA Drive, Bloomington, IN 47403. (800) 366-2682. http://www.cota.org.
Second Wind Lung Transplant Association, Inc. 9030 West Lakeview Court, Crystal River, FL 34428. (888) 222-2690. 〈http://www.arthouse.com/secondwind〉.

lung transplantation

the transfer of an entire pulmonary organ system to a new site. The procedure may be performed as a combined cardiopulmonary transplantation.

lung transplantation

Grafting of a donor lung into a recipient with end-stage lung disease, usually caused by pulmonary fibrosis, chronic obstructive lung disease, or pulmonary hypertension. Lung transplantation may be performed as a single-organ operation or as part of a combined heart-lung transplantation, e.g., in congenital heart disease. Immunosuppressive therapy with cyclosporine or tacrolimus, azathioprine, and corticosteroids is necessary to minimize the risk of rejection, which is caused by T lymphocyte activity against the donor tissue. Rejection is diagnosed through the use of bronchial biopsies and pulmonary function tests. Acute rejection, characterized by dyspnea, fever, hypoxemia, rales, and tachypnea, must be differentiated from infection. Chronic rejection, a problem in 25% to 50% of cases, presents as bronchiolitis obliterans and occurs 6 to 14 months after the transplant. Flow rates progressively decrease, with few additional symptoms; bronchodilator therapy is not effective, and giving higher doses of immunosuppressives has mixed success. Sixty percent of lung transplant recipients live 2 years.
See also: transplantation
References in periodicals archive ?
2] and high-frequency percussive ventilation, Jane remained significantly hypoxic and hypercapnic (see Table 1) resulting in her placement on veno-venous ECMO via double lumen cannulation of the right internal jugular vein, as well as placement on the lung transplantation list (HD 6).
It occurs to a total of 50 percent to 80 percent of patients in a period of five years following lung transplantation.
Pulmonary arterial hypertension and lung transplantation.
The investigators compared transplantation registry data on 205 patients who underwent lung retransplantation from 2001 through May of 2006 (the modern-era group) with data on a historical cohort that underwent lung retransplantation from 1990 to 2000, and a third group of patients who underwent primary lung transplantation in the modern era.
5) In young patients with cystic fibrosis who are being considered for bilateral lung transplantation, CT has limited utility and has not been shown to change the surgical approach and, thus, may be omitted in this limited circumstance.
We retrospectively analyzed data from 75 patients referred to the Department of Cardiovascular and Respiratory Sciences of the University of Rome La Sapienza from January 2001 to February 2004 for clinical and serologic (hepatitis C virus, hepatitis B virus, HHV-8, and cytomegalovirus) evaluation for lung transplantation.
Therapeutic modalities now include parenteral prostanoids, oral endothelin receptor antagonists, PDE5 inhibitors, and lung transplantation (SOR: A; for PDE5 inhibitors, SOR: B)
Editorial includes information on such topics as cell biology, pharmacology and drug development, clinical trials, rehabilitation, surgery, mechanical ventilation and lung transplantation.
Tager and Ginns (1996) divided the complications of lung transplantation into three groups: those related to the surgical procedure (retained secretions, atelectasis, air leaks, pneumothorax, airway dehiscence); those related to the immunology of transplant (hyperacute, acute, and chronic rejection of the transplanted organ); and those related to immunosuppressive therapy (infection, malignancy, other organ dysfunction due to medication side effects).