September 26, 2017

Lung Transplant

Patient consideration for lung transplantation

Lung transplantation is usually reserved to treat end-stage lung disease, when all other options have been searched. Patients considered good candidates are those with highest probability of success after receiving a transplant. Not only do patients have to qualify by physical ailment but also pass psychological evaluation. The psychological evaluation assesses how well a patient is prepared to live with post-management of looking after the donated organ.

Who is a proper donor?

“Living donor”

  • Age < 55 years
  • No pulmonary disease
  • Normal chest radiographcs
  • Normal bronchoscopic examination
  • Normal gas exchance (oxygen and carbon dioxide)
  • Negative testing for hepatitis B and HIV
  • Blood matching, ABO groups
  • Matching size

“Non-heart beat donors”

The “non-heart beat donors” usually come from a recently deceased donor. Lung are removed and placed over ice. Using specialized techniques to preserve the lungs during their transportation, the lungs are able to adequately survive between 5-8 hours. Lungs from younger donors tend to fair better than those of older “non-heart beat donors”.

Factors that effect placement on the waiting list

There are different factors that decide where a patient is placed on a waiting list. By this point, patients are usually very sick and a lung transplant is the last and only option. Sicker patients are placed at the top and are more likely to be recipients of the next available organ donor. The waitlist is based on urgency on how badly a patient is in need of a lung transplant.

Some of these factors include:

  • Age
  • Diabetes
  • Function of the lungs
  • Body mass index
  • Adequate blood-oxygen exchange
  • Need for mechanical ventilation
  • Overall diagnosis

Series of events that happen

  • Donor is found
  • Family is contacted
  • Donor organs are checked and a transplant team sent to pick up organs
  • Patient brought to PACU
  • Transplant lasts 8-10 hours

Post-management

Ventilation, the patient will remain “on vent”, or assisted breathing, until they are able to breath sufficiently on their own. This will also help the transplant team monitor the progress and recovery of the new lungs.

Chest tubes: May stay in place 48-72 hours, depending on how much drainage is needed from the surgical site.

Immunosuppression

  • Corticosteroids
  • Calcineurin inhibitor
  • Cell-cycle inhibitor

Risks of rejection and infection

  • Fight bacterial infection, pneumonia can develop
  • Bleeding and hemorrhaging
  • Airleaks
  • Systemic arterial circulation failure (if organs not revascularized properly)
  • Airway complications – strictures or collapses of airways

Early signs of rejection:

  • Dyspnea
  • Fever
  • Hypoxemia
  • Pain at the site of transplant
  • Swelling
  • Change in heart rate
  • Urinating less often