Lung Transplant: Everything You Need To Know
Lung transplantation is a procedure that has evolved over time and offers more and more promising figures. A person undergoing this type of surgery will need continuous emotional support and a lot of discipline to change their lifestyle.
Lung transplantation is a surgical procedure in which one or both diseased lungs are replaced by healthy ones, provided by a deceased donor. It is a complex surgery that significantly improves a person’s quality of life.
The first successful lung transplants were performed in the 1960s by Dr. James Hardy and then by professional Denton A. Cooley in 1968. The initial patient was a two-month-old girl with congestive heart failure and recurrent pneumonia.
This type of procedure is performed when a person has a terminal lung disease or a serious pathology that has proven resistant to conventional treatments. In any case, the lung transplant candidate must meet some requirements to be eligible.
Why is a lung transplant performed?
Typically, a lung transplant is only performed when all available treatments have been carried out to correct lung failure and these have not yielded results. In general, it is indicated for people under 75 years of age who have a serious pathology in the lungs.
Some of the diseases that can lead to a transplant of this type are the following:
- Chronic obstructive pulmonary disease (COPD).
- Cystic fibrosis.
- Pulmonary hypertension.
- Pulmonary fibrosis.
- Bronchiectasis
- Sarcoidosis
Indications
Candidates for lung transplantation must meet certain requirements, as we have already mentioned. Only if they conform to them are they eligible for the procedure. Among the criteria to take into account are the following:
- Age: it is established that the maximum must be 75 years, although above 55 it is considered to be at higher risk.
- Body mass index: should not be higher than 35.
- Risk of dying: it is recommended in patients who have a 50% risk of death during the following two years if the transplant is not performed.
- High chance of survival after transplant – based on your general health.
- Commitments: the transplant recipient should make a firm commitment not to smoke again, not to use psychoactive drugs, and to participate in a pulmonary rehabilitation program.
Those who have an active infection are ruled out. Also those who have had cancer in the last two years or have a serious health problem in another organ. Likewise, those who are malnourished or who do not have a support network that guarantees adherence to post-transplant treatment.
Lung transplant risks
Lung transplantation is a complex surgery and has considerable risks. The most important are rejection and infection. The first occurs when the patient’s immune system attacks the transplanted lung or lungs.
Anti-rejection medications are used to prevent this from happening, but they can cause side effects, such as weight gain, stomach problems, and facial hair growth. These drugs also make a person more prone to developing other diseases, such as diabetes, osteoporosis, kidney failure, and high blood pressure.
Therefore, after a transplant of this type, the patient must observe strict hygiene measures and avoid contact with crowds or sick people. Finally, another possible risk is that of clot formation after surgery, due to increased blood clotting.
How is it the procedure?
The process of performing a lung transplant begins long before the surgery takes place. After a patient has been evaluated and found eligible for the procedure, the next step is to enter a waiting list until there is a donor.
While the transplant candidate awaits the donation, they must follow the medical indications regarding their lifestyle. When a lung is available for the procedure, compatibility with the patient is evaluated. If it is adequate, the transplant is carried out.
Preparation
A person on the waiting list for lung transplantation should be prepared to attend the call of the doctors as soon as it occurs. It is best to have a suitcase ready with personal items and regular medications.
When the candidate arrives at the hospital, he undergoes a series of tests to verify compatibility. Your general health is also assessed. If there are doubts about it, the procedure can be canceled. If everything is in order it will take place almost immediately.
Surgical intervention
Lung transplant surgery is carried out under general anesthesia. If only one lung is to be replaced, the intervention lasts between four and eight hours; if both lungs are transplanted it can take between six and twelve hours.
The procedure to follow is as follows:
- An extracorporeal circulation system is activated.
- A cut to the side of the chest is made when only one lung is to be replaced. If they are both, the cut is made below the chest and reaches both sides of the chest.
- One or both lungs are removed and the blood vessels and airways of the new organs are attached to the patient’s body.
- Probes are inserted to drain air, fluid, and blood out of the chest. These will stay there for several days, until the new lungs expand normally.
- Once the lungs are working, the heart-lung machine is removed.
Postoperative
The intervened patient must stay in the hospital for a period of between 7 and 21 days. The most common is that you spend several days in the intensive care unit (ICU) after surgery. However, each medical center has its own protocols.
The first 24 to 48 hours are crucial. During this period, a meticulous observation is carried out in which the functioning of the lungs, heart, kidneys and mental state are evaluated, in particular. Likewise, it is verified that there are no added bleeding or hemorrhages.
Recovery
The most common is that the recovery period is extended for six months, in the first instance. During the first three, a close follow-up is done to evaluate the functioning of the lungs and prevent any complications.
In this first stage, it is necessary to go frequently to the hospital for tests that include x-rays, biopsies, laboratory tests and electrocardiograms. Reaction to medications is also monitored.
After this phase, the patient must make adjustments in his life, which include taking immunosuppressants and regularly attending therapies and consultations. The first year after lung transplantation is the most critical. Afterwards, all the risks begin to diminish.
The most common is that there are weekly consultations during the first three months; then quarterly consultations for a year. Then an annual consultation for the next 5 to 10 years.
What is the survival rate after a lung transplant?
Based on available data, the average life span after lung transplantation is 5.8 years. This can vary, depending on the person’s previous illness. Those with cystic fibrosis survive 8 or more years after surgery.
Patients with idiopathic interstitial pneumonia survive 4.8 years on average. 32% of those who have undergone this procedure live 10 years or more. The highest risk of death occurs during the first 12 months, so that is where the controls are reinforced.
