Lung Transplant Week

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General Information

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Lung transplantation is now considered to be a standard of care therapeutic intervention for several end-stage lung diseases that are refractory to or continue to progress despite exhaustive medical therapy. While lung transplants are not a cure, they can extend and improve a patient’s quality of life. Increasing numbers of lung transplants are being performed in the US and worldwide. Overall success continues to improve, but significant challenges remain that span from donor supply and patient selection through the post-transplant period that are being actively addressed by ongoing research.

Recipient selection
The list of pulmonary diseases for which lung transplant can be considered continues to expand. Recent data indicate that the outcomes for patients with connective tissue diseases such as scleroderma can have similar outcomes following lung transplant as other recipients.

  • Chronic obstructive pulmonary disease
  • Idiopathic pulmonary fibrosis
  • Cystic fibrosis
  • Idiopathic pulmonary arterial hypertension
  • Eisenmenger syndrome
  • Emphysema due to alpha-1 antitrypsin deficiency

In addition to age, underlying pulmonary disease and accompanying co-morbidities, transplant evaluation increasingly considers the overall frailty of the patient. Frailty refers to the concept of a patient being more vulnerable to poor outcomes because of overall poor health or weakness. A recent study demonstrated that frailty is an independent risk factor for delisting and death on the wait list.

Although more lung transplants are being performed every year, wait list mortality has continued to increase. This is thought to be partly due to the current lung allocation score system which prioritizes patients who have the highest risk of dying on the waiting list. Thus, sicker patients are being considered for transplant. Also, the availability of donor lungs is a factor. 75% of lung transplant surgeries in the US are bilateral, using both lungs from the same donor.  The aggressive use of technologies such as extracorporeal membrane oxygenation (ECMO) has been shown to be a viable bridge to transplantation for patients with respiratory failure and/or pulmonary hypertension whose lungs can no longer function without life support.

Organ availability
Access to sufficient and quality organs remains one of the most significant challenges in lung transplantation. It is estimated that only 15% of lungs are deemed suitable for transplantation from multi-organ donors.  Novel technologies such as ex vivo lung perfusions systems are being explored as a means of expanding the supply of viable donor lungs. Commonly referred to as “lung in a box”, EVLP preserves marginal donor lungs for prolonged periods of time. In the United States the EVLP system is approved under the Humanitarian Device Exception. Ongoing trials are underway for full device approval.

Post-transplant Care
Survival for lung transplant patients in the US is about 88% at one year, 72% at 3 years and 50-60% at 5 years. Younger patients (<50 years old) tend to have better survival when compared to older patients. Likewise, patients with cystic fibrosis tend to have better survival rates than those patients with other indications.

While a patient’s quality of life usually improves significantly following a lung transplant, post-transplant care can be arduous. Complications can occur, including rejection, infection and graft dysfunction. Most patients will experience at least one episode of rejection post-transplant during the first year. Transbronchial biopsies are performed regularly to monitor for rejection and most episodes respond to treatment. Pulmonary rehabilitation post lung transplantation has been shown to further improve physical function and thus quality of life after the transplant. 

Long term survival is ultimately limited by the development of chronic rejection, also known as Chronic Lung Allograft Dysfunction which can occur in two forms: a restrictive form called restrictive allograft syndrome and an obstructive form called bronchiolitis obliterans syndrome (BOS). Novel therapies are under investigation to treat bronchiolitis obliterans.

 


 

Four Facts About Lung Transplant

  1. One organ donor can save eight lives and change the lives of more than 50 people.

  2. Donated lungs require special methods of preservation to keep them viable and may be preserved between 4-6 hours between the time of procurement and transplantation.

  3. A lung transplant transforms lives affected by diseases such as cystic fibrosis, pulmonary fibrosis, Sarcoidosis, pulmonary hypertension and COPD.

  4. While transplants give recipients a second chance, they aren't a cure. Rejection rates for lung transplant recipients is worse than that of any transplanted organ.

Last Reviewed: September 2018