Lung Transplantation

What is lung transplantation? A surgery to partially or completely replace one or both diseased lungs of a patient (plus sometimes the heart) with healthy organs from a human donor. Lung transplantation has been around for over 40 years, with the first successful transplant in 1983. Over the past few decades, there has been significant scientific advances in organ transplantation.

Who gets a lung transplant? Lung transplantation is reserved for patients with certain lung conditions in end-stage, when all other treatments have been exhausted. In the US, the most common underlying diseases of patients receiving lung transplantation are:

  1. COPD/emphysema (including alpha-1 antitrypsin deficiency)
  2. Idiopathic Pulmonary Fibrosis (IPF)
  3. Cystic Fibrosis (CF)
  4. Primary Pulmonary Hypertension (PPH)
  5. Other diseases, including Sarcoidosis, bronchiectasis and certain pneumoconioses (including silicosis and asbestosis)

What are the types of lung transplantation?

  1. Single-lung: Usually the worse functioning lung is replaced. If there is no significant difference, the right is usually favored because of technical factors. The operation generally lasts from 4-8 hours.
  2. Double-lung: Also known as bilateral. This may be sequential (“double single”) or en bloc (both as one unit). The sequential method is preferred. The operation generally lasts from 6-12 hours.
  3. Heart-lung: If the patient has severe heart disease as well, he/she might be a candidate for both organs transplanted.
  4. Lobe: Transplantation of a section of lung, rather than the whole lung or both lungs.

What is the source of donor lungs? Lungs for transplantation are usually taken from someone who has been declared brain-dead but remains on life-support. The donor should have been otherwise healthy.

What are the generally accepted criteria to be a transplant recipient?lung_transplant

  1. End-stage lung disease without other available options
  2. No other significant chronic condition
  3. No current infection (exception may include CF and bronchiectasis)
  4. No recent cancer
  5. No AIDS, HIV or active hepatitis
  6. No alcoholism, drug abuse or current smoking
  7. Acceptable weight range
  8. Good social support system and psychosocial profile
  9. Able to comply with post-transplant care

Once accepted as a good candidate, the potential recipient must carry a pager with them at all times in case a donor becomes available. He/she should be prepared to relocate to their chosen transplantation center.

What is a Lung Allocation Score? Currently, prospective lung transplantation recipients 12 and older are assigned a Lung Allocation Score. This score is based on a number of factors including diagnosis, age, body mass index (BMI), FVC, pulmonary artery pressure, distance walked in 6 minutes, serum Creatinine, and use of supplemental oxygen. The LAS is designed to help prioritize potential recipients based on the probability of survival over the next year without the transplant, the probability of surviving the transplantation, and the projected life expectancy after transplant. Children under 12 are prioritized based on time on the waitlist.

What are other factors considered? Most importantly, the donor must be matched as closely as possible to the recipients blood type to decrease the chances of rejection. The donated lung should be large enough to be able to support the recipient’s breathing but still fit within the chest cavity. Given equivalent LAS, the time on the waitlist will also be considered.

What is a transplant team? Lung transplantation is only performed at certain medical centers in the US. There is usually a team of doctors, including a thoracic surgeon, pulmonologist, cardiologist, and transplant coordinator. Other team members include social worker, psychiatrist, financial coordinator, nurses, nutritionist and other specialists.

What happens after surgery? Typically, the patient remains hospitalized for 1-3 weeks, but could be longer if complications arise. After discharge from the hospital, the patient will attend physical rehab to build up strength and endurance. During this time, he/she will not be allowed to drive.

What are the risks of transplantation? The three main risks are:

  1. Bleeding (especially early on)
  2. Infection (not only because of the surgery but because of medicines used to help prevent rejection)
  3. Rejection (The recipient’s immune system “sees” the donor tissue as “foreign” or as an “invader” and will try to destroy it. Signs of rejection may include fever, worsening shortness of breath, flu-like symptoms, weight loss, and worsening lung function)

What can be done to lessen these risks? Immediately after surgery, the recipient will be placed on a number of “immunosuppressants” or medicines designed to keep the body from destroying the donor organ. These medicines will be taken life-long and must be strictly adhered to. The doctor may make adjustments in these medicines depending upon the clinical situation. The medicines will leave the recipient more susceptible to infection, however. Hygiene will be more important, as will careful follow-up.

What is the prognosis for lung transplantation? Based on data from 2006, the 1-year survival is about 85%, the 5-year survival about 50% and the 10-year survival about 25%.

What is on the horizon? One major hurdle has been the low number of lungs available for people desperately in need. New research in Canada hopes to repair “damaged” donor lungs using outside-the-body gene therapy in a specialized body-temperature chamber in order to decrease the number of donated lungs that would otherwise have to be discarded. This therapy might also improve survival of the lung post-transplant.

Where can I find more information on lung transplantation?

  1. United Network for Organ Sharing
  2. International Society for Heart and Lung Transplantation
  3. Second Wind Lung Transplant Association
  4. National Institutes of Health
  5. American College of Chest Physicians