Lung transplantation | Doctors & surgery information

A lung transplant is necessary for some end-stage lung diseases. In this case, no other therapeutic measures will help and the last chance is a new healthy lung from a donor.

Sometimes the heart is also affected by the lung disease. In some rare cases, a combined heart and lung transplant must then be performed. Nowadays, a combined transplant is rare, as much of the damage to the heart recedes once the lungs are working normally again. In most cases, a simultaneous heart and lung transplant is only performed if the patient also has a heart defect.

Diseases that may make a lung transplant necessary

• Chronic obstructive pulmonary disease (COPD, also known colloquially as smoker's lung)
• Pulmonary fibrosis (disease of the lung connective tissue)
• Cystic fib rosis or cystic fibrosis (metabolic disease of the lungs and other organs)
• Hypersensitivity pneumonitis or exogenous allergic alveolitis (inflammatory change in the alveoli due to inhalation of organic dusts)
• Pulmonary hypertension (high blood pressure in the pulmonary circulation)
• Cortisone-resistant pulmonary sarcoidosis (inflammatory disease of the lungs with tissue changes)
• Pulmonary emphysema (destruction of the lung tissue due to increased air content)
• Severe lesions or injuries to the lungs
• Bronchiectasis (irreversible enlargement of the medium-sized airways)
• Lymphangioleiomyomatosis (hereditary, increased growth of smooth muscle)
• Bronchiolitis obliterans (inflammation and scarring of the bronchioles)

Procedure for lung transplantation

The exact procedure for a lung transplant naturally also depends on the previous illness. Chronic infections such as cystic fibrosis, for example, require a bilateral transplant, whereas a unilateral lung transplant may be sufficient for all other lung diseases.

The allocation of donor organs is subject to strict criteria. As lungs can only be donated post-mortem, two independent doctors must determine the brain death of the donor. The organs are then removed and transported in cool boxes to a transplant center. The recipient is also prepared for the operation there.

At the beginning of the operation, an incision is made between the eighth and ninth ribs. After the diseased lung has been removed, the donor lung is inserted. This is then connected to all relevant structures such as bronchi and vessels. In the case of a bilateral lung transplant, the same procedure is then carried out with the second lung. The patient's chest is then closed again. Over the next few hours, the patient is weaned off the ventilator and is usually allowed to move from the intensive care unit to the normal ward after around three days. The entire hospital stay usually lasts around three weeks, during which the patient also receives physiotherapy to help them mobilize quickly.

Requirements for a lung transplant

Overall, there are not enough suitable donor organs, which is why there are strict criteria for their allocation. The most important criteria are how much the patient needs a donor lung and how good their chances of success are. This includes whether the patient has a life expectancy of less than 18 months and whether their lung function is measurably deteriorating. The age is also taken into account, which should be under 60 for unilateral lung transplants and under 50 for bilateral lung transplants. Other illnesses and pre-existing conditions are also taken into account. A lung transplant is contraindicated, for example, in the case of severe arteriosclerosis or alcohol, drug or medication abuse.

Risks of a lung transplant

A lung transplant carries the same risks as any other operation. These include inflammation, bleeding and an intolerance reaction to the anesthetic. Infections after a lung transplant usually manifest themselves as pneumonia. However, sepsis and infections of the gastrointestinal tract, kidneys, urinary tract or nervous system can also occur. These are usually caused by viruses, but can also be triggered by fungi.

However, there are also some specific risks associated with lung transplantation. There can be both a narrowing and a gaping of the seams between the bronchi and pulmonary vessels. In addition, the lungs may fail and the body may reject the new lungs. The body views the new organ as a foreign body and activates its defense mechanisms. Acute rejection reactions can nowadays be easily suppressed with the help of immunosuppressants.

One of the most serious complications is bronchiolitis-obliterans syndrome (BOS). This can be a reason for a transplant as well as developing after the transplant. This is a chronic rejection reaction that causes inflammation of the bronchioles and the associated narrowing of the airways. In the worst case, the rejection reaction can be so severe that the patient needs a new lung, otherwise they will die.

After the lung transplant

Thorough aftercare is important in the initial period following the operation. There are weekly check-ups with a doctor. The doctor examines the blood values and carries out X-ray and ultrasound examinations. It is also particularly important that the medication is constantly adjusted. Immunotherapy after lung transplantation can have serious side effects, which is why the dose must be checked regularly. To this end, the level of medication in the blood is determined each time and, if necessary, the doctor will change the dose of medication. If the check-ups do not reveal any problems, the interval between appointments can be extended. Even a long time after the operation, the patient should continue to see the doctor regularly every three months or so. Otherwise, there is a risk that a chronic rejection reaction will remain undetected and therefore untreated.