Lung Transplant Week

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General Information

Lung Transplant Week

What is Lung Transplantation?

Lung transplantation is a surgical procedure in which one (single lung transplant) or both lungs (double lung transplant) that are severely diseased are replaced with healthy lungs from a donor. It is a procedure that is only considered for people with several forms of very advanced lung disease when the disease is progressing (worsening) and all other medical therapies have failed to control the disease. 

Who is a Candidate for Lung Transplantation?

People with several forms of advanced lung disease may be candidates for transplantation, including those with chronic obstructive pulmonary disease (with or without alpha-1-antitrypsin deficiency), idiopathic pulmonary fibrosis, cystic fibrosis, primary pulmonary hypertension, sarcoidosis and other rare conditions such as lymphangioleiomyomatosis.

What is Involved in Considering Lung Transplantation?

Lung transplantations are performed at specialty medical centers that have expert teams of healthcare professionals. There are two key components of considering individuals for transplantation: referral to a specialty transplant center, and actual listing of the individual on the transplant wait list.  The individual’s lung disease, other medical conditions, and overall health and life circumstances are important considerations in determining candidacy for transplantation. In general, people with advanced lung disease are referred to a transplant center and when their life expectancy without transplantation is likely shorter than their expected survival if a transplant is done.  Patients referred to a transplant center are not obligated to undergo transplantation; the referral process enables potentially suitable patients to be evaluated by and to get to know members of the transplant team, so that if and when the time is right, they may have the opportunity to undergo the procedure.

Listing of Patients on the Transplant List

Several conditions must be met for a person to be placed on the transplant wait list:

  • The lung disease must be very severe and worsening despite fully optimized medical treatment
  • Several medical conditions such as recent cancer and some chronic infections must be absent
  • The individual must not have psychological conditions that make it impossible to adhere to complex medical treatment after transplantation
  • Candidates for transplantation must be willing to take medications that suppress the immune system for the rest of their life.
  • Candidates for transplantation must agree not to smoke, drink alcohol or use illicit drugs
  • Candidates must be able and willing to come to necessary follow-up appointments
  • Candidates must have adequate financial (eg insurance) coverage for the surgery itself and the necessary follow-up care
  • There are additional lung-disease-specific considerations that determine patients’ candidacy for transplantation. These were highlighted recently in a consensus document for the selection of lung transplant recipients (see references below).

There is no absolute age limit for lung transplantation, but in general transplantation should be avoided among people over the age of 75 due to the presence of several concurrent medical conditions that worsen patients’ outcomes.

Suitable candidates are placed on a waiting list.  A non-profit organization called the United Network of Organ Sharing (UNOS) oversees the transplant system and helps prioritize peoples’ position on the wait list, depending on a Lung Allocation Score, that helps to determine the urgency with which a person needs transplantation. Higher scores indicate a higher urgency of need.

The limited number of available donor lungs is a key factor that limits the number of lung transplants performed.

Preparing for Lung Transplantation

It is important for people preparing for lung transplantation to work closely with their healthcare providers to ensure that their medical treatment (including medicines, oxygen, immunizations) is optimized. It is also important to ensure adequate nutrition, and most transplant centers require that individuals undergo pulmonary rehabilitation to optimize exercise tolerance prior to transplantation.

Care After Lung Transplantation

Most people who undergo lung transplantation require hospitalization for a few weeks, and some may require a period of rehabilitation after surgery. People with lung transplants need to take at least 3 medications to suppress the immune system starting from around the time of surgery and continuing for the rest of their life.  The immune-suppression medications help to keep the body from rejecting the transplanted lung. Additional medications to help prevent infections are also required. In addition, people who have undergone lung transplantation require regular contact with members of the transplant team and intermittent follow up visits and testing. Routine testing after transplantation includes blood tests, lung function testing, chest-x-rays and bronchoscopies (wherein a flexible tube with a video camera is passed into the lungs to inspect the surgical attachment sites and enable monitoring for rejection or infection).

Complications of Lung Transplantation

Several complications can occur following lung transplantation. Complications may include early failure of the lung graft, acute immune rejection, complications related to the surgical connection sites in the airways and/or blood vessels, blood clots, infections, side effects or toxicity from needed medications, increased risk for certain types of cancer, chronic immune rejection and other medical complications such as diabetes, kidney insufficiency or heart complications.  The syndrome of chronic rejection known as “Bronchiolitis obliterans syndrome (BOS)” is a major complication following lung transplantation. People who develop BOS develop shortness of breath and their lung function testing shows progressive obstruction to the flow of air. BOS is he leading cause of death more than 1 year following lung transplantation.  Occasionally, consideration of repeat lung transplantation is required.

Outcomes of Lung Transplantation

People who undergo lung transplantation can, in general, expect improvements in their lung function, activity and exercise tolerance and in their quality of life.  However, despite many technical advances in recent years, mortality related to lung transplantation remains high. The average survival for all adults who undergo lung transplantation is 5 to 6 years. Age and the diagnosis for which people undergo lung transplantation influences the outcomes.  One-year survival rates range from 75 to 85% and 5 year survival rates range from 55 to 60%, depending on the initial diagnosis.   Further research is still needed to improve patients’ outcomes following lung transplantation.

References

 


 

Four Facts About Lung Transplant

  1. In 2013, approximately 12,000 pairs of lungs were donated for transplantation

  2. In 2013, there were 1794 lung transplants in the US; 60% men and 40% women, now waiting for transplant, 1646.

  3. Lungs are the most difficult of all solid organs to transplant

  4. To date there are not any drugs developed specifically for lung transplant

 (Source: www.lungtransplantfoundation.org)