Lung Transplant Surgery, Survival, Organ Rejection. Risk-Benefit

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lung transplantation is a Surgical procedure, in which, the lungs are replaced by lungs from a donor.
Lung transplantation is the ultimate treatment option for patients with end-stage lung disease.
Lung can be transplanted from dead person, or from living donor.
A living person can donate only one lobe of one lung.
Lobe is portion of the lung.
Right lung consist of 3 lobes (upper, midder and lower). While left lung has only 2 lobes (upper and lower).
Lung transplantation itself is risky and costly decision, but they can also extend life expectancy for those, with end stage pulmonary disease.
The most common reasons for lung transplantation is:
Chronic obstructive pulmonary disease (COPD), including emphysema;
Idiopathic pulmonary fibrosis;
Cystic fibrosis;
Idiopathic (formerly known as "primary") pulmonary hypertension;
Alpha 1-antitrypsin deficiency;
Replacing previously transplanted lungs that have since failed;
There are several requirements, for donor and recipients:
Blood type should be the same. mismatch of blood type, can lead to a strong response by the immune system and subsequent rejection of the transplanted organs.
Tissue typing.
Every cell displaying HLA molecules. If donor and recipient HLA are too distinct, hosts immune system considers it as "non-self", and attacks it. resulting in the rejection of the tissue bearing those cells.
HLA means human leukocyte antigen. These complexes of both the donor and recipient, should be as closely matched as possible to prevent graft rejection. That’s why close relatives who are genetically similar are “better” donors.
Lung sizes should match. Not to big for donor but large enough to adequately oxygenate the patient.
Donor and his(her) Lungs should be healthy.
Technically lung transplantation is difficult operation and it requires around 8-12 hours. Sometimes more.
The average hospital stay is one to three weeks, can be longer in case of complications.
After this stage, patients are typically required to attend rehabilitation gym for approximately 3 months.
Light weights, exercise bike, treadmill, stretches and more are all a part of the rehabilitation programme.
Because certain nerve connections to the lungs are cut during the procedure, transplant recipients cannot feel the urge to cough, or feel when their new lungs are becoming congested.
They must therefore make conscious efforts to take deep breaths and cough in order to clear secretions from the lungs.
After transplantation, As with any surgical procedure, there are risks of bleeding and infection.
But, most concerning issue is Transplant rejection.
Because the transplanted lung or lungs come from another person, the recipient's immune system will see it as an invader and attempt to neutralize it.
Transplant rejection is a serious condition and must be treated as soon as possible.
Transplant rejection is the risk, both immediately after the surgery, and continuing throughout the patient's life.
It can develop any time after transplantation.
Signs of rejection
fever;
flu-like symptoms, including chills, dizziness, nausea, general feeling of illness, night sweats;
increased difficulty in breathing;
worsening pulmonary test results;
increased chest pain or tenderness;
increase or decrease in body weight of more than two kilograms in a 24-hour period.
In order to prevent transplant rejection and subsequent damage to the new lung or lungs, patients must take a regimen of immunosuppressive drugs.
This is a lifelong commitment, and must be strictly adhered to.
he immunosuppressive regimen is begun just before or after surgery. Usually the regimen includes ciclosporin, azathioprine and corticosteroids.
Despite preventive medication, rejection can happen any time.
Another problem is risk of infections. Because of immunosuppressive drugs.
Antibiotics may be prescribed in order to treat or prevent such infections.
Prognosis:
The prognosis of lung transplantation is dependent on many factors but average 5 year survival is 53.4%. and 10 year survival - 28.4%
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