Lungs are organs for respiration located in the thorax/chest cavity. They are spongy air-filled organs. The inhaled air is carried through the thorax to the lungs via bronchi. These bronchi are further divided into alveoli where the oxygen from the air is absorbed and the carbon dioxide from blood is transferred to the air to be exhaled. As lungs perform the vital function for the body any problem to lung functioning may prove fatal. |
The lung transplant process involves the process of replacing a diseased and problematic lung with a healthy donor lung. A lung donor can be a deceased or living donor. It may include replacement of single or both lungs or sequential lung transplant that is one lung at a time and also lung transplant along with donor's heart. It is the best-accepted treatment for failing lung or end-stage disease that does not respond to any medical treatment. The lung transplant survival rate has improved a lot in past years. According to the source's the survival rate after 1 year of lung transplant is 80% and after 5 years is 70 %.
It has an increased median lifespan of 6.2 years. About 4600 lung transplantations are carried out worldwide. The survival rate has risen from a median of 4.3 years (1990-1998) to 6.5 years (2009-2016) over the past decade. In addition to survival advantages, in the vast majority of patients, quality of life improvements is achieved. In the field of lung transplantation, several advances have taken place over the past decade. For patients waiting for lung transplantation, extended indication criteria and bridging strategies have contributed to increased waiting lists and changes in allocation schemes worldwide.
Types Of Lung Transplant
According to the type of donor -
a) Living donor lung transplant
b) Deceased donor lung transplant
According to the section of the lung a) Single lung transplant
b) Double lung transplant
c) Sequential lung transplant
d) Both lungs along with the heart of the donor
Indications For Lung Transplant
End-stage lung disease or failing lung conditions that cannot be solved with any other medicines and treatment may require a lung transplant.
a) Some medical conditions include- b) cystic fibrosis
c) chronic obstructive pulmonary disease (COPD)
d) Pulmonary hypertension e) Heart disease
f) Pulmonary fibrosis. g) sarcoidosis
i) Lymphangioleiomyomatosis j) hereditary conditions.
FACTORS AFFECTING THE ELIGIBILITY FOR LUNG TRANSPLANT
a) Individuals with active infection are not the right candidate for a lung transplant.
b) Individuals with a medical history of cancer cannot be operated on for lung transplants.
c) Individuals with serious diseases such as kidney, liver, or heart diseases
d) Individuals who are unwilling to quit smoking and alcohol or are unable to make lifestyle changes necessary to keep your donor lung healthy.
e) Individuals who do not have a supportive family, friends, or relatives.
Treatment Procedure For Lung Transplant
The information from medical documents, physical examination, fitness evaluation, a diagnostic test will be done to consider the patient for a lung transplant.
The evaluation will be done on grounds of psychological and social evaluation of stress, finances, support of the peers.
A blood test to match the blood group of the donor. diagnostic tests like x-rays, ultrasound, lung function tests, lung biopsy, CT scan, and even dental examinations are done. In women, gynecological tests, mammography, and Pap test also may be performed.
Immunization to be done before transplant. Cessation of smoking and being nicotine-free is important before the waiting list.
Once all the tests are performed the name is put on the waiting list. The waiting period may vary according to the availability of lung that matches, same blood group, the geographical location of the donor, your overall health, the urgency of the treatment, donor age, and lung size.
A single lung transplant procedure requires 4-8 hours while a double lung transplant may require
12 hours of surgical time.
The pre-operative procedure includes changing into a hospital gown, placement of IV line, placing bracelets on the wrist for identification in hospital, placement of catheters, tube insertion for artificial breathing, draining the contents from the stomach, and introduction of anesthesia.
The incision is made on the chest through which the lung will be replaced. The site of incision may depend on the type of transplant being done. A cardiopulmonary bypass machine will be used during the surgery to provide blood and oxygen to the body. The diseased lung is removed and a new healthy donor lung is placed and attached to the blood vessels and airways.
The incision will be closed with stitches and staples. A drainage tube will be placed in a position through the incision to drain fluids, blood, and air from the lungs so that the lungs can fully expand. A catheter may also be placed in position for the administration of medications.
Then the patient is transferred to the recovery room and then to ICU for few days to be kept under observation for few weeks. During the stay, the vital signs, infection, and signs of rejection of the lung are closely monitored and provided with mechanical ventilation. The patients are kept on immunosuppressants so that the body does not attack the transplanted lung as it is a foreign object.
Lung Transplant Recovery
In the hospital room- After few weeks of stay the breathing and stomach tubes are removed and the patient can start with a liquid diet. The physiotherapist will work with the patient to develop efficient breathing. The dietitian will help in counseling with diet and help in lifestyle modification and retain healthy life.
At home- the incision area has to be kept clean and dry. Pushing, pulling, and lifting heavy weights should be avoided for few weeks after surgery. Follow-up for 3 months post-surgery is required. During follow up certain tests like pulmonary function tests, blood tests, chest x- rays, bronchoscopy, lung biopsy, etc may be performed to monitor the state of the surgery. Lung biopsy may be done to check the signs of rejection and infection, this may be done during the bronchoscopy procedure itself. For the signs of shortness of breath, fever, cough, chest congestion, and infection, Medications like immunosuppressants, antibiotics, antiviral and antifungal may be prescribed to prevent infection. Rehabilitation and psychological counseling will also be done during this period.
Individuals have a good ability to breathe
Individuals can return to routine life and perform normal daily activities. Individuals can have a prolonged and healthy life year.
Painful recovery process due to sternum segmentation in certain patients. Developing lung efficiency.
A lengthy stay in hospitals for rehabilitation purposes.
Risk of rejection of organ and thus having low prognosis.
As the patients are on immunosuppressants they have a large chance of infection. Thus, the patient requires frequent hospitalization so that the viruses and bacteria do not settle into the transplanted lungs.
Lung Transplant Risks Risk and complications that arise due to lung transplant may prove fatal. Some risk includes blockage of blood vessels, blockage of the airway, pulmonary edema, blood clots. The major risk is rejection and infection.
Risk of rejection - even though the donor's lung is the best match for the individual, still the receiver's body may identify it as a foreign object and reject it. This risk is high soon after the transplant and then gradually decreases. The chances of lung transplant failure are more due to this cause. To avoid this the patient is placed on immunosuppressants.
Risk of infection- as the patient is on immunosuppressants it suppresses the immune system of the patient. Due to this reason, the patient remains susceptible to various infections. Infections may lead to decreased prognosis.
Side- effects of immunosuppressants- weight gain, osteoporosis, diabetes, kidney failure, cancer, hypertension, GIT problems, etc.
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