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Lung and Heart-Lung Transplantation

by Martin Hertl, MD, PhD, Paul S. Russell, MD

Lung transplantation is done for people whose lungs no longer function. Most recipients are people who have severe chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, alpha 1 -antitrypsin deficiency, or primary pulmonary hypertension. Usually, one lung is transplanted, but two 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. Because preserving a lung for transplantation is difficult, lung transplantation must be done as soon as possible after a lung has been obtained.

Over 80% of people who receive a lung transplant survive for at least 1 year.

Lung transplants can come from a living donor or from someone who has recently died. 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.

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.

Complications

The risk of infection is high because the lungs are continually exposed to air, which contains bacteria and other microorganisms that can cause disease. 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 of a lung transplant can be difficult to detect, evaluate, and treat. 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. Later, scar tissue may form in the small airways and gradually block them, possibly indicating gradual rejection.