Lung Transplantation

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Lung transplantation is the therapeutic measure of last resort for patients with end-stage lung disease who have exhausted all other available treatments without improvement. A variety of conditions may make such surgery necessary. As of , the most common reasons for lung transplantation in the United States were: [1]. Despite the severity of a patient's respiratory condition, certain pre-existing conditions may make a person a poor candidate for lung transplantation: [2].

The history of organ transplants began with several attempts that were unsuccessful due to transplant rejection. Animal experimentation by various pioneers, including Vladimir Demikhov and Henry Metras, [4] during the s and s, first demonstrated that the procedure was technically feasible.

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James Hardy of the University of Mississippi performed the first human lung transplant on June 11, From to , multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing. It was only after the invention of the heart-lung machine , coupled with the development of immunosuppressive drugs such as ciclosporin , that organs such as the lungs could be transplanted with a reasonable chance of patient recovery.

The first successful transplant surgery involving the lungs was a heart-lung transplant , performed by Dr. Bruce Reitz of Stanford University in on a woman who had idiopathic pulmonary hypertension. In , Vera Dwyer, a woman from County Sligo in Ireland , was diagnosed with an irreversible, chronic and fibrotic lung disease. Later on that year, she received a single lung transplant in the UK. In November , Ms. Dwyer was recognized as the world's longest surviving single lung transplant recipient in an event at the Mater Hospital in Dublin.

There are certain requirements for potential lung donors, due to the needs of the potential recipient. In the case of living donors, this is also in consideration of how the surgery will affect the donor: [2].

You must be in the best shape you can be going into your transplant.

While a transplant center is free to set its own criteria for transplant candidates, certain requirements are generally agreed upon: [2]. Patients who are being considered for placement on the organ transplant list undergo extensive medical tests to evaluate their overall health status and suitability for transplant surgery.

Before , donor lungs within the United States were allocated by the United Network for Organ Sharing on a first-come, first-served basis to patients on the transplant list. This was replaced by the current system, in which prospective lung recipients of age of 12 and older are assigned a lung allocation score or LAS, which takes into account various measures of the patient's health. The new system allocates donated lungs according to the immediacy of need rather than how long a patient has been on the transplant list. Patients who are under the age of 12 are still given priority based on how long they have been on the transplant waitlist.

The length of time spent on the list is also the deciding factor when multiple patients have the same lung allocation score. Patients who are accepted as good potential transplant candidates must carry a pager with them at all times in case a donor organ becomes available. These patients must also be prepared to move to their chosen transplant center at a moment's notice. Such patients may be encouraged to limit their travel within a certain geographical region in order to facilitate rapid transport to a transplant center.

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.

When a lung transplant is needed

In living donation, this procedure requires the donation of lobes from two different people, replacing a lung on each side of the recipient. Donors who have been properly screened should be able to maintain a normal quality of life despite the reduction in lung volume. In deceased lobar transplantation, one donor can provide both lobes. Many patients can be helped by the transplantation of a single healthy lung.

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The donated lung typically comes from a donor who has been pronounced brain-dead. Certain patients may require both lungs to be replaced. This is especially the case for people with cystic fibrosis , due to the bacterial colonization commonly found within such patients' lungs; if only one lung were transplanted, bacteria in the native lung could potentially infect the newly transplanted organ. Some respiratory patients may also have severe cardiac disease which would necessitate a heart transplant. These patients can be treated by a surgery in which both lungs and the heart are replaced by organs from a donor or donors.

A particularly involved example of this has been termed a "domino transplant" in the media. First performed in , this type of transplant typically involves the transplantation of a heart and lungs into recipient A, whose own healthy heart is removed and transplanted into recipient B. While the surgical details will depend on the type of transplant, many steps are common to all these procedures.

Lung Transplantation

Before operating on the recipient, the transplant surgeon inspects the donor lung s for signs of damage or disease. If the lung or lungs are approved, then the recipient is connected to an IV line and various monitoring equipment, including pulse oximetry. The patient will be given general anesthesia , and a machine will breathe for him or her. It takes about one hour for the pre-operative preparation of the patient. A single lung transplant takes about four to eight hours, while a double lung transplant takes about six to twelve hours to complete.

A history of prior chest surgery may complicate the procedure and require additional time. In single-lung transplants, the lung with the worse pulmonary function is chosen for replacement. If both lungs function equally, then the right lung is usually favored for removal because it avoids having to maneuver around the heart, as would be required for excision of the left lung.

In a single-lung transplant the process starts out after the donor lung has been inspected and the decision to accept the donor lung for the patient has been made. An incision is generally made from under the shoulder blade around the chest, ending near the sternum.

An alternate method involves an incision under the breastbone. The donor lung is placed, the blood vessels and bronchial tube reattached, and the lung reinflated. To make sure the lung is satisfactory and to clear any remaining blood and mucus in the new lung a bronchoscopy will be performed.

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When the surgeons are satisfied with the performance of the lung the chest incision will be closed. Numerous tests are performed during a lung transplant evaluation, which can include:. Also, anyone who continues to smoke cannot receive a lung transplant. If they are, surgery on the recipient begins immediately, while the lungs are in transit to the center. Surgeons may perform either a single lung transplant or a double lung transplant. A surgeon will make a large incision in the chest during a lung transplant.

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The incision varies by the type of lung transplant:. Complete unconsciousness is maintained with general anesthesia during the surgery. Some people receiving a lung transplant will need to go on cardiopulmonary bypass during the surgery. While on bypass, the blood is pumped and enriched with oxygen by a machine, rather than by the heart and lungs.

The time to full recovery after a lung transplant varies widely between people. Some people may leave the hospital within a week. The weeks after lung transplant are busy, filled with activities intended to ensure long-term success. These include:. What Are the Functions of the Lungs?

Lung Transplant Process

The lungs have two functions: Take in oxygen, which cells need to live and carry out their normal functions Get rid of carbon dioxide, a waste product of the body's cells The two lungs are separated from each other by the mediastinum, an area that contains: The heart and its large vessels Trachea windpipe Esophagus Thymus Lymph nodes The right lung has three sections, called lobes.

The left lung has two lobes. What Happens When We Breathe? When you breathe: The air enters the body through the nose or the mouth. It then travels down the throat through the larynx voice box and trachea windpipe. Air enters the lungs through tubes called main-stem bronchi.

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One main-stem bronchus leads to the right lung and one to the left lung. In the lungs, the main-stem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli. Previous Section Next Section. Chest Clinic Pulmonology Chest Clinic Clinical Trials.

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