Lung transplantation

What does lung transplantation refer to?

Through transplant surgery, modern medicine enables patients to defeat certain terminal illnesses by having a sick organ removed and replaced with a healthy donor organ. Options range from bone marrow transplants for blood cancer to kidney, heart or lung transplants.

Transplant surgery is a field of medicine that requires multidisciplinary cooperation among professionals as a team. In the case of lung transplants, for instance, thoracic and cardiac surgeons, lung specialists (pneumologists), anesthesiologists and intensive care doctors cooperate.

The transplanted organs may stem from the patient's own body (skin transplant) or from other people. Selected organs, such as a kidney, may be obtained from a living donor, however, the vast majority of organs, such as lungs, originate from recently deceased people.

A lung transplant is an option for patients affected by terminal damage to the lungs, where no other treatment is likely to improve the condition.

Among them are cystic fibrosis, pulmonary fibrosis, emphysema / COPD, more rarely pulmonary hypertension, sarcoidosis and other specific cases.

When is a lung transplantation performed?

Two requirements must be met in order to perform a lung transplant: severe loss of lung function and a compatible organ donor.

The former is assessed by thoroughly examining lung function, blood values, concomitant and consequential diseases. That way, the thoracic surgeon is able to weigh the risk of the procedure against the prospects of success of a lung transplant.

Apart from the requirements (severity of the disease, lack of alternative treatment options, severely reduced quality of life), certain obstacles may stand in the way. For instance, except for a few rare cases, no lung transplantation is performed in patients older than 65 years of age. Additional diagnoses leading to disqualification are: an uncontrollable infection (except for the lungs), multiple coronary artery disease, cancer ( unless completely cured), severe organ damage unrelated to the lung disease, serious mental disorders and addiction (abstinence from smoking for a minimum of 1 year), obesity and a lack of patient compliance to the therapy regimen (including regular intake of medication).

After carefully evaluating the patient, their name is entered into the transplant waiting list. After this, patients can only wait for a suitable organ donor.

How is a lung transplantation carried out?

Once a suitable organ has been found for you, you will be called immediately. A surgical team will initiate the process of retrieving the organ right away, while at the same time you will be called to your hospital. Because every minute from organ removal to implantation counts, you will be prepared for surgery while your donor organ is being retrieved.

An anesthesiologist will induce general anesthesia.

In the following step, in case of a unilateral lung transplant, the thoracic surgeon will make a skin incision from the shoulder blade up to your sternum. In case your remaining lung is functional enough to supply you with oxygen during the procedure, there will be no need for a heart-lung-machine. At first, the pathological lung is removed and the donor lung is engrafted by connecting it to the bronchi, arteries and veins. The length of this procedure can range from 4 to 8 hours.

In case both lungs are being transplanted (which is done more frequently due to better results), the skin incision will be carried out horizontally across the sternum and the adjacent ribs. Even here, a heart-lung-machine may be avoided in some cases by transplanting one lung after the other. This procedure may take up to 12 hours.

Also minimally invasive lung transplantations are carried out in many centers. This technique offers reduced surgical trauma, minimal incisions and specialized instruments. Unfortunately though, it is also more difficult to perform, given that surgeons must operate with a reduced overview of the surgical field.

The procedure is followed by a period of supervision in an intensive care unit. The main goal is to step away from artificial ventilation as soon as possible, so that the newly transplanted lung can get used to its functions. Simultaneously, immunosuppressive therapy is initiated, which is supposed to prevent the patient’s body from rejecting the foreign organ.

Patients will stay in the hospital for 3 weeks after the surgery which is followed by an inpatient rehabilitation program aimed to secure the patient’s recovery as well as to educate them about the correct handling of their new organ.

What is the prognosis of a lung transplantation like?

The 1 year survival rate following lung transplantations is 80-90%. After 5 years, only 50% of the transplanted lungs will remain functional which in most cases is caused by the body’s chronic rejection reaction. Since this reaction is observed way more frequently with lung transplants than with other organs, research of this area is being heavily pushed.

Lifelong and regular follow-ups are the cornerstone of early detection and prevention of a potential rejection reaction. Furthermore, the effectivity of the immunosuppressive therapy has to be regularly assessed and its dosage may need to be adapted.

As immunosuppressive treatment predisposes patients to viral and bacterial infections, patient compliance is crucial.

In case you have further questions regarding the possibilities and prognosis associated with transplant surgery and especially lung transplants, do not hesitate to get in touch with your thoracic surgeon.