Lung Transplantation

  1. What is lung transplantation?
    • It is a surgical procedure in which a patient's diseased lungs are partially or completely replaced by the lungs of a donor (deceased and very rarely, living).

  2. What are the diseases in which lung transplantation is indicated?
    • Cystic fibrosis (CF) - An inherited disease characterized by an abnormality in the glands that produce sweat and mucus. It is chronic, progressive, and is usually fatal.
    • Chronic obstructive pulmonary disease (COPD) - A group of lung diseases that can interfere with normal breathing due to lung damage often induced by smoking/ fossil fuel fume exposure.
    • Pulmonary artery hypertension - Increased pressure in the arteries of the lungs.
    • Heart disease affecting the lungs - These may require a heart-lung transplant.
    • Interstitial Pulmonary fibrosis (IPF) - Scarring of the lungs of known or unknown cause.
    • Other diseases causing severe lung damage - sarcoidosis, histiocytosis, or LAM
    • In adults, it is mostly for COPD and IPF and in children it is for cystic fibrosis.

  3. In which patient is lung transplantation indicated?
  4. Lung transplantation is indicated for patients with irreversible, progressively disabling end-stage lung disease (ESLD). The typical lung transplant candidate has a life expectancy of less than 18 months, is dependent on supplemental oxygen, has severe exercise intolerance, is < 65 years of age, and reports poor ESLD-related quality of life.


  5. How is patient selection for lung transplantation done?
  6. The evaluation of potential candidates for lung transplantation is done by a multidisciplinary team comprising pulmonologists, thoracic surgeons, nurses, mental health specialists, nutritionists, pharmacists, and transplant coordinators.


  7. What are the types of donors?
    • Deceased donor
      • Donor after Brain stem death
      • Donor after circulatory death (non-heart-beating donor)
    • Very rarely, lobe transplant from living donor

  8. What are the types of lung transplantation?
    • Single lung transplantation
    • Double lung transplantation
    • Heart-lung transplantation
    • Transplantation of lung lobes from living related donors

  9. What are the outcomes for lung transplantation?
    • It was only in the mid-1980s that lung transplantation was accepted as a treatment for ESLD. The risks and benefits of this procedure must be carefully weighed for each patient. This is because, even with considerable advancement, only half of the recipients survive more than 5 years after receiving a lung transplant.
    • The primary goal of lung transplantation is to prolong life rather than to permanently cure ESLD.
    • Most lung transplant recipients experience significant improvements in lung function, exercise tolerance and quality of life (QoL).

  10. What is the lung transplantation scenario in India?
    • There are very few hospitals in India that perform lung transplantation. A total of 75 lung transplantations have been performed in South India in the past three years from 2013 to 2015 (Source: Indian Transplant Newsletter).

Acknowledgement:
  1. B V Murali Mohan MD MRCP(UK) SCE (Resp Med)(UK)
    Narayana Hrudayalaya - Mazumdar Shaw Medical Centre
    Bangalore
  2. Primer on Transplantation - 3rd edition. Edited by Donald Hricik MD



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