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Lung and Heart-Lung Transplantation

By Martin Hertl, MD, PhD, Jack Fraser Smith Professor of Surgery, Director of Solid Organ Transplantation, and Chief Surgical Officer, Rush University Medical Center

Lung transplantation is done for people whose lungs no longer function. Most recipients are people who have one of the following disorders:

One or both lungs can be transplanted. When a lung disorder has also damaged the heart, one or both lungs and a heart may be transplanted at the same time. Single and double lung procedures are about equally common and are at least 8 times more common than heart-lung transplantation.

Because preserving a lung for transplantation is difficult, lung transplantation must be done as soon as possible after a lung has been obtained.

The percentage of people who survive after receiving a lung transplant survive is .

  • At 1 year: Over 80%

  • At 5 years: Over 50%

Donors

Lung transplants can come from a living donor or from someone who has recently died. Donors must be under 65 years old, have never smoked, and not have a lung disorder. The size of the donor's and recipient's lungs must match.

A living donor cannot donate more than one entire lung and usually donates only one lobe. A person who has died can provide both lungs or the heart and lungs.

Procedure

Before the procedure, the recipient is often given antibiotics to prevent infections from developing.

Through an incision in the chest, the recipient’s lung or lungs are removed and replaced with those of the donor. The blood vessels to and from the lung (pulmonary artery and pulmonary vein) and the main airway (bronchus) are connected to the transplanted lung or lungs.

The operation takes 4 to 8 hours for one lung and 6 to 12 hours for two lungs. A heart and lung may be transplanted at the same time. The hospital stay after these operations is usually 7 to 14 days.

Drugs to inhibit the immune system (immunosuppressants), including corticosteroids, are started the day of transplantation. These drugs can help reduce the risk that the recipient will reject the transplanted lung.

Complications

Transplantation can cause various complications.

Infections

The risk of infection is high after lung transplantation because of the following:

  • The lungs are continually exposed to air, which contains bacteria and other microorganisms that can cause infections.

  • Immunosuppressants, which are needed to help prevent rejection of the transplanted lung, make the body less able to defend against infections.

Poor healing

The site at which the airway is attached sometimes heals poorly. Scar tissue may form, narrowing the airway, reducing air flow, and causing shortness of breath. Treatment of this complication consists of widening (dilating) the airway—for example, by placing a stent (a wire-mesh tube) in the airway to hold it open.

Rejection

Rejection of a lung transplant can be difficult to detect, evaluate, and treat. Doctors use a flexible viewing tube (bronchoscope) to periodically examine the airways and remove a sample of lung tissue. This procedure helps them identify rejection and check for infections.

Most people who receive a lung transplant develop some symptoms of rejection within a month of transplantation. Symptoms include fever, shortness of breath, cough, and fatigue. Fatigue develops because the transplanted lung cannot provide enough oxygen to supply the body.

In up to one half of people, symptoms of chronic rejection gradually develop more than a year after transplantation. In such cases, doctors usually detect scar tissue that has formed in the small airways and gradually blocked them.