Considering a Lung Transplant

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Reasons For Lung Transplants

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As a last resort, single- or double-lung transplants, as well as heart-lung and partial-lung transplants are possible. There aren’t enough donor lungs for everyone who needs them.

Transplant centers prioritize according to local criteria along with some generally accepted national guidelines. For example, a history of noncompliance with medical instruction or multiple concurrent diseases can classify a patient as a poor pulmonary transplant recipient.

In June 2020, a woman in her 20s with irreversible lung damage from COVID-19 was the first in the United States to receive a double-lung transplant. Organ transplants may become more common in severe cases of COVID-19. —Medscape

Anatomy posters and models simplify explanation of medical procedures. There have been many improve­ments to lung transplant surgery since the 1980s. This includes powerful anti-rejection drugs and bloodless medical management techniques when warranted. As of 2005, the most common reasons for lung transplantation in the United States were:

  • 27% chronic obstructive pulmonary disease (COPD), including emphysema
  • 16% idiopathic pulmonary fibrosis
  • 14% cystic fibrosis
  • 12% idiopathic (formerly known as “primary”) pulmonary hypertension
  • 5% alpha 1-antitrypsin deficiency
  • 2% replacing previously transplanted lungs that have since failed
  • 24% other causes, including bronchiectasis and sarcoidosis

Increasingly, lung transplantation is an option among severe COVID-19 patients. A challenge that researchers are discovering is an unexpected disease pattern in COVID-19 lungs: The virus invades the cells that line blood vessels, called endothelial cells, and this is causes blood clots—9 times more than typical influenza. These clots can lead to thrombosis or strokes.

It is now clear that COVID-19 damages more than your lungs. In a medical review of patients around the world, coronavirus compromises the kidneys, liver, heart, brain and nervous system, skin and gastro­intestinal tract. Hospitals cannot just staff pulmonolo­gists during the pandemic. COVID-19 is a “multi-system disease.”

Separating Fact From Fiction

Cinema dramatizations often feature a single hospital or doctor that receives a viable lung in the nick of time. Before the rolling credits, a groggy patient thanks the omnipotent surgeon. We leave the show feeling that is the end of the story.

Lung transplant

In reality, doctors exhaust all alternative treatments. A spirometer is the main piece of equipment used for basic Pulmonary Function Tests (PFTs). Doctors rule out lung diseases such as asthma, bronchitis, and emphysema with this tests. Many other tests that assure the best possible match include:

  • Blood typing – The recipient’s blood type must match the donor’s. This is due to antigens that are present on donated lungs. A mismatch of blood type can lead to a strong response by the immune system and subsequent rejection of transplanted organs
  • Tissue typing Ideally, the lung tissue would also match as closely as possible between the donor and the recipient, but the desire to find a highly compatible donor organ must be balanced against the patient's immediacy of need
  • Chest X-ray – PA & LAT, to verify the size of the lungs and the chest cavity
  • Pulmonary function tests
  • CT Scan (High Resolution Thoracic & Abdominal)
  • Bone mineral density scan
  • Gated cardiac blood pool scan (MUGA)
  • Cardiac stress test (Dobutamine/Thallium scan)
  • Ventilation/perfusion (V/Q) scan
  • Electrocardiogram
  • Cardiac catheterization
  • Echocardiogram

A stable patient who is not confined to a hospital receives a pager. Within a moment’s notice this individual must be willing to relocate to a hospital qualified to perform the surgery and provide follow-up rehabilitation. Automobile driving and many other tasks are suspended at least 3 months until receiving occupational therapist clearance.

Post-Surgery Recovery

Immediately following surgery, the patient is in an intensive care unit for monitoring, normally for a few days. A ventilator assists breathing. Nutritional needs are generally met with feeding tubes while chest tubes drain excess fluids.

⚠️ Cutaneous complications common post-transplant

As use of lung transplant becomes more common, pulmo­no­lo­gists should be aware of post-transplant derma­tologic compli­ca­tions. The most common are HSV-1, HSV-2, varicella zoster, HHV-6 and KSHV. Zoster (shingles) rates in transplant reci­pients are between 3 and 25 percent and are more common in older recipients of thoracic trans­plants receiving mycophenolate-containing immuno­suppres­sive regimens. —Cleveland Clinic

Even with full recovery and a daily cocktail of immuno­suppres­sive drugs and antibiotics, the average donor lung longevity is 3 to 5 years. Effectively living without an immune system is challenging. Nerve damage can interfere with common autonomic functions such as coughing. Heart rate responds less quickly to physical exertion. Voice may change.

Survival Prognosis
1 year5 years10 years
Lung transplant83.6%53.4%28.4%
Heart-lung transplant73.8%46.5%28.3%

A lung transplant can be expensive before, during, and after the surgery. The typical cost is $500,000–$800,000, depending on whether the procedure involves one or both lungs. Health insurance may cover many, but not all, of the costs. Protecting your lungs by avoiding cigarettes, vaping, and wearing masks during annual flu season and especially through a pulmonary pandemic is the course of wisdom to remain healthy.

Coronavirus pandemic information represents a historic snapshot of fluid events. To support the writing of useful articles about pulmonology, ClinicalPosters sells human anatomy charts, scientific posters and other products online. Slide extra posters into DeuPair Frames without removing from the wall or leave an encourag­ing comment to keep the work going.

References
  1. Lung transplantation. en.wikipedia.org/wiki/Lung_transplantation (Jul 9 2020)
  2. Lung Transplant on COVID–19 Patient Is a First for the US. medscape.com/viewarticle/932238 (Jul 9 2020)
  3. New Study Published in the New England Journal of Medicine Shows COVID–19 Causes Blood Vessel Damage. angio.org/new-study-published-in-the-new-england-journal-of-medicine-shows-covid-19-causes-blood-vessel-damage/ (Jul 9 2020)
  4. How coronavirus affects the entire body. cnn.com/2020/07/10/health/coronavirus-entire-body-effects-columbia/index.html (Jul 9 2020)
  5. Lung Transplant Surgery: Preparation and Procedure. upmc.com/services/transplant/lung/process/surgery (Jul 9 2020)
  6. Patient Blood Management Strategies and Techniques. upmc.com/services/patient-blood-management-bloodless-medicine/techniques (Jul 9 2020)
  7. How Much Does a Lung Transplant Cost? costhelper.com/lung-transplants.html (Jul 9 2020)
  8. Planning to Pay for a Transplant. cff.org/Life-With-CF/Treatments-and-Therapies/Lung-Transplantation/What-to-Consider-Regarding-a-Lung-Transplant/Planning-to-Pay-for-a-Transplant/ (Jul 9 2020)
  9. Lung illustration by Kevin Williams.

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