Lung Transplant

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 Caucasian race) that results in the affection of cells producing mucus, sweat, and digestive juices that cause death overtime. 
• 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. 

• Routine blood investigations
• V/Q Scan 
• Pulmonary function test 
• Chest HRCT  
• ECG and 2 D Echocardiogram 
• Coronary Angiogram 
• CTPA and CPET  
• Women need to get a Pap smear, gynecology evaluation, and a mammogram. 

The steps of procedure for the Lung Transpant Surgery are- 

• A plastic tag and bracelet with name and number is assigned to the patient. 
• An IV (intravenous line) is inserted into the arm of the patient before the surgery begins. 
• Then the venous catheters are placed in the neck and groin of the patient. Also, BP monitoring lines are inserted in the radial and femoral arteries. A Urinary catheter is also placed and a nasogastric tube is placed in the stomach. 
• General anesthesia is given to the patient and a breathing tube is put into the throat. The patient is attached to the ventilator.
• An incision is 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 put in the patient’s chest. 

The risks of lung transplant surgery include- 

• Bleeding (heavy)
• Infection 
• Thrombosis  
• Dehiscence of the airway suture line 
• Pulmonary edema  
• Lung rejection 
• Osteoporosis and bone fractures  
• High cholesterol levels

• The patient is kept in the ICU for 1-2 weeks after the surgery. The vitals are monitored, the catheter is placed to empty the bladder and a flexible bronchoscopy is done. The ventilator is removed after 1-3 days. 
• The nasogastric tube is taken out when bowels resume normal function.  
• Blood samples are taken many times in a day, this is done to monitor the health of the new lungs, kidneys and liver. The patient is given opioids for pain control.  
• The immunosuppressive medicines are gradually increased to monitor the bone marrow, kidney, and liver function. 
• ICCU Nurses, ID doctors, and physiotherapists will monitor the patients closely.