What is Lung Transplant
Cardiovascular and Thoracic Surgeon, Jaslok Hospital, 25 years of experience
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What is Lung Transplant?
A lung transplant is a surgical procedure to replace irreversibly diseased lungs with healthy lungs. This surgery is advocated for those patients who are dependent on oxygen and those who have a high possibility of death due to the underlying lung disease within the next 6-12 months.
These diseases include COPD, pulmonary fibrosis, bronchiectasis, and cystic fibrosis. This now includes post-COVID lung fibrosis and those on VV ECMO.
Most lungs are harvested from brain dead donors, very rarely donation is carried out after circulatory death from deceased donors. Lung transplants are done commonly between the ages of 5 – 70 years.
Let us tell you in detail about Lung transplants in today’s article.
- What are the types of Lung Transplant procedures?
- What is the purpose of Lung Transplant Surgery?
- Preparation before Lung Transplant Surgery?
- Precautions that should be taken before a Lung Transplant
- What happens before Lung Transplant Surgery?
- Who is a part of the Lung Transplant Surgery team?
- What happens during Lung Transplant Surgery?
- What happens after a Lung Transplant Surgery?
- Care to be taken at home after Lung Transplant Surgery
- Post-Lung Transplant Surgery follow up
- Immunosuppressive therapy for Lung Transplant Surgery
- What are the signs of Lung Transplant Surgery rejection?
- What are the risks of Lung Transplant Surgery?
- When should an individual NOT have Lung Transplant Surgery?
- What is extracorporeal membrane oxygenation (ECMO)?
- ECMO used as a bridge to Lung Transplant
- When is a Covid-19 patient recommended a Lung Transplant Surgery?
- Survival Rates of Lung Transplant Surgery
- What is the cost of Lung Transplant Surgery in India?
What are the types of Lung Transplant procedures?
- Single lung: is the transplant of 1 lung (rarely carried out)
- Double lung: is the transplant of both lungs simultaneously
- Heart-lung transplant: is the transplant of the heart-lung block
- Living transplants: in which eligible adults donate a single lobe to implant in a child.
What is the purpose of Lung Transplant Surgery?
A lung transplant is considered the last option for the treatment of respiratory failure and may be required in the end stages of the following conditions :
- Chronic obstructive pulmonary disease (COPD): is a chronic lung condition that results in obstruction of the airflow. This results in difficulty in breathing, productive cough, and wheezing. Commonly seen amongst chronic smokers.
- Cystic Fibrosis: It is an inherited life-threatening disorder (seen mainly in the Caucasian race) that results in the affection of cells producing mucus, sweat, and digestive juices that cause death over time.
- Pulmonary hypertension: It is an abnormal increase in the blood pressure in the arteries of the lungs usually caused by an untreated hole in the heart. Results in right-sided heart failure.
- Pulmonary fibrosis: when lung interstitial tissues get scarred and thickened. It has the worst prognosis among all lung diseases.
Preparation Before Lung Transplant Surgery
Before a lung transplant surgery, the doctor performs the following tests to identify the extent of damage to the lungs. Apart from this, the doctor will examine the condition and function of the lungs and liver.
Some of these tests include:
- General blood tests
- Chest HRCT
- ECG.
- 2 D Echocardiogram. ( Know more about- What is Echocardiography? )
- Coronary Angiogram. ( Know more about- What is Coronary Angiography? )
- CTPA
- V/Q Scan
- Pulmonary function test
- CPET
- Immunization
- Women will get a Pap smear, gynecology evaluation, and a mammogram.
If the investigations indicate irreversible lung damage then the patient is waitlisted for a transplant depending upon the urgency. Once a donor is allocated the transplant is immediately carried out.
Precautions that should be taken before a Lung Transplant Surgery During the waiting time, the doctor advises some precautions, such as:
- DO NOT SMOKE or else your name will be struck off the waiting list. (Know more about- How to quit smoking ?)
- If your doctor prescribes any medicines, take them at the right time
What happens before Lung Transplant Surgery?
- Before the transplant, the transplant surgeon will go over the procedure with the patient and take an informed video consent.
- Chest Xray and blood samples are collected
- Immunosuppressive medications and IV antibiotics are administered.
Who is part of the Lung Transplant Surgery team?
- Transplant surgeons
- Transplant anaesthesiologist
- Pulmonologist
- Chest physiotherapists
- ID specialists
- Transplant nurses
- Social worker
- Psychologist
- Dietitian
What happens during Lung Transplant Surgery?
A lung transplant requires a stay of 2-3 weeks at a hospital.
- A plastic bracelet or tag with the name and a number assigned to the patient are put.
- An intravenous line will be inserted into the arm of the patient before being wheeled in for surgery.
- Venous Catheters are inserted in the neck and groin. BP monitoring lines are placed in the radial and femoral arteries.
- A Urinary catheter is also inserted.
- A nasogastric tube is inserted to empty the stomach.
- General anesthesia is given.
- A breathing tube is put into the throat and attached to the ventilator.
- An incision will be made by the surgeon in the chest. Usually, for a bilateral sequential transplant, the incision is going to be made horizontally across the chest below the breasts.
- The patient is placed on cardiopulmonary bypass using a heart-lung machine.
- The diseased lungs are removed and replaced with the donor’s lungs.
- 4-6 drainage tubes are going to be put in your chest.
What happens after a Lung Transplant?
- After the surgery, the patient will be taken to the surgical intensive care unit (ICU) for up to 1-2 weeks.
- The patient will be connected to monitors that will constantly show the vital signs, which include heart rate, breathing rate, and oxygen level.
- The catheter will stay in your bladder until the patient can self void (urinate) and output monitoring is not required.
- Flexible bronchoscopy is regularly carried out.
- The ventilator is weaned off over a period of 1-3 days.
- The nasogastric tube is taken out when bowels resume normal function.
- Blood samples are going to be taken several times each day. These are done to see the health of the new lung(s), kidneys, liver.
- The patient will be given opioids for pain control.
- The immunosuppressive medicines are gradually stepped up monitoring the bone marrow, kidney, and liver function.
- ICCU Nurses, ID doctors, and physiotherapists will work closely with the patient.
Care to be taken at home after Lung Transplant Surgery
- Keep the incision clean and dry.
- Careful bathing instructions should be followed.
- Maintain good personal hygiene as well as keep your hands and mouth clean.
- Avoid lifting heavy objects for 12 weeks after surgery.
- Preferably do not drive.
- The medicines given by the doctor may cause some side effects including, dizziness, lack of sleep, headache, swollen gums, and acne.
- In general, it can take at least three months for a person to fully recover.
- For their entire life, the patient is advised to avoid crowds and avoid meeting anyone who is ill with communicable diseases.
Post-Lung Transplant follow up
The follow-up visits will include:
- Still more Blood tests
- Pulmonary function tests
- Chest X-ray and HRCT
- Bronchoscopy guided lung biopsy
Immunosuppressive therapy for Lung Transplant Surgery
- To allow the transplanted lungs to survive in the patient, certain special medicines are given for the rest of their lives. These include Azathioprine, Tacrolimus, Prednisolone, Mycophenolate mofetil.
What are the signs of Lung Transplant Surgery rejection?
Rejection is a major risk post-lung transplant. It occurs because the body’s own white blood cells try to kill the transplanted lung.
Signs may include :
- Fever of 100.4°F (38°C) or higher
- Flu-like symptoms
- Redness or swelling of the incision
- Blood or any other fluid leaking from the incision
- Feeling of breathlessness
- Fluid accumulation within the lung
- Unexplained tiredness
- Productive cough
What are the risks of Lung Transplant Surgery?
- Bleeding
- Infection
- Thrombosis. ( Know more about- What is Deep Vein Thrombosis?)
- Dehiscence of the airway suture line
- Pulmonary edema
- Lung rejection
- Osteoporosis and bone fractures. ( Know more about- What is Bone fractures? )
- High cholesterol levels
When should an individual NOT have Lung Transplant Surgery?
- Infection is present that has not been treated.
- Cancer is metastatic which means that it has spread to other areas.
- Severe heart problems
- Multiple other organ problems will result in him/her not being able to survive the lung transplant.
- Patients who can’t comply with all treatment requirements for getting a lung transplant.
What is extracorporeal membrane oxygenation (ECMO)?
Extracorporeal membrane oxygenation (ECMO) is a procedure in which blood from the body is pumped outside into a heart-lung machine that has an artificial oxygenator that removes carbon dioxide and adds oxygen to the blood.
ECMO is used in situations in which the heart and lungs need to rest. It was used for ARDS and is now Covid-19 as well.
ECMO used as a bridge to Lung Transplant
Doctors now use V V ECMO as a bridging strategy for patients who have severe end-stage lung disease but are waiting for their turn on the transplant list. This allows patients in critical conditions to get support and long periods of time before they receive their transplant. It also helps them become more active and ambulatory before the lung transplant.
When a Covid-19 patient is recommended for Lung Transplant Surgery?
Lung transplantation is considered to be a life-saving alternative for patients with COVID-19-associated respiratory failure.
Firstly, the typical criteria for Lung transplant should be considered-
- Patients with BMI above 30 are at high risk of a lung transplant. Very low BMI also increases the risk of complications
- Other notable co-morbidities, such as severe coronary artery disease are absent.
- The patient considered should be below 65 years of age.
- The patient should have only single-organ dysfunction.
- Sufficient time should be given for the lung to recover (3 weeks on ECMO).
- There must be radiological confirmation showing irreversible lung disease. The patient should be ought to be conscious and able to move all 4 limbs.
- Patients should have recent negative SARS-CoV-2 PCR results.
Survival Rates of Lung Transplant Surgery
The International Society for Heart and Lung Transplantation Registry reported a 1-year survival for 80% of patients and 5-year survival for 54% of patients.
What is the cost of Lung Transplant Surgery in India?
The total cost of Lung Transplant Surgery in India can range from INR 25,00,000 to INR 30,00,000. But the cost of lung transplant surgery may vary across different hospitals.
If you are coming from abroad, in addition to the cost of a lung transplant, there will be an additional cost of accommodation and food, the cost of local travel, etc. So the total cost of a lung transplant can range from INR 32,00,000 to INR 36,00,000.
We hope that we could answer your questions regarding Lung transplants through this article.
If you want more information and treatment of Lung Transplant, you can contact a Cardiovascular and Thoracic Surgeon
We only aim to give you information through this article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.
