Over the past 25 years, lung transplantation has become a viable treatment option for patients with a variety of end-stage lung diseases. A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. Depending upon the medical condition transplant may involve replacement of single, double (both lungs) or lung along with heart.
The most common indications for lung transplantation are
- Advanced chronic obstructive pulmonary disease (COPD),
- idiopathic pulmonary fibrosis (IPF),
- cystic fibrosis (CF),
- emphysema due to alpha-1 antitrypsin deficiency,
- Idiopathic pulmonary arterial hypertension (IPAH).
Other rare indications are spectrum of end-stage lung disease from sarcoidosis to lymphangioleiomyomatosis (LAM) to pulmonary Langerhans’ cell histiocytosis
WHO REQUIRES LUNG TRANSPLANT?
Lung transplantation should be considered for patients with advanced lung disease whose clinical status has progressively declined despite maximal medical or surgical therapy. Candidates are usually symptomatic during activities of daily living and have a limited expected survival over the next two years. In addition, the ideal candidate should be free of significant other organ dysfunction and extrapulmonary manifestations of a systemic disease.
- Uncontrolled or untreatable pulmonary or extrapulmonary infection
- Active Mycobacterium tuberculosis infection
- Malignancy in the last two years
- Significant dysfunction of other vital organs
- Significant coronary artery disease or heart failure
- Significant chest wall/spinal deformity
- Active tobacco smoking, Drug or alcohol dependency
- Unresolved psychosocial problems or noncompliance with medical therapy
- HIV infection, Ongoing hepatitis B or C viral infection
- Absence of a consistent or reliable social support system
- Obesity: body mass index (BMI) ≥35 kg/m2
RISK OF LUNG TRANSPLANTATION:
Lung transplantation is associated with two major complications
1-Risk of Rejection
Our immune system defends our body against any foreign substances. Even with the best possible match between the recipient and the donor, immune system will try to attack and reject new lung or lungs. For this special group of drugs are prescribed to suppress immune system in an effort to prevent organ rejection. The patient will likely take these anti-rejection drugs for the rest of his life.
These Immunosuppressive drugs may cause noticeable side effects, including weight gain, acne, facial hair, stomach problems etc. Some medications can also increase risk of developing new or aggravating existing conditions, such as: Diabetes, Renal failure, Osteoporosis, Cancer, Hypertension etc.
2-Risk of Infection
These Immunosuppressive drugs suppress our immune system, making our body more vulnerable to infections, particularly in lungs.
The median survival for all adult recipients is 5.7 years, but bilateral lung recipients appear to have a better median survival than single lung recipients. After the postoperative recovery, most recipients are able to resume almost normal lifestyle. Over 80 percent report no activity limitations. Furthermore, multiple studies have documented improved overall and health-related quality of life after lung transplantation.
Dr. Sanjeev K. Khulbey, MBBS, MS, MCH,
Senior Consultant Cardiothoracic Surgeon
Apollo Health City, Hyderabad