Lung transplantation is generally performed for patients between 18 and 65 years old, but sometimes performed on children and newborns as treatment options. Recently, the transplant was successfully performed on a 10-year-old Pennsylvania girl, Sarah Murnaghan, although she continues to have some difficulty. Most of the lung transplants are taken from a brain-dead person. Sometimes a part of the lung may be donated by a healthy non-smoking adult, and this is known as a ‘living transplant.’
Lungs perform the life-sustaining function of taking in oxygen required in all body cells and get rid of the carbon dioxide released by the cells from the bloodstream. This vital function is hindered when the lungs are damaged due to certain conditions like severe cystic fibrosis, chronic obstructive pulmonary disease (COPD), increased pressure within the arteries to the lungs (Pulmonary hypertension), scarring of lungs (Pulmonary fibrosis), and other diseases like sarcoidosis, histiocytosis, or lymphangioleiomyomatosis. When the lung functions cannot be improved by any other medical treatments, then a lung transplantation is the only option to recover and extend life.
Lung transplantation treatment options and strategies currently available:
Single Lung Transplants – This is performed when one lung is severely damaged and replaced with the donor lung. This procedure is unsuitable when the lungs are infected as in cystic fibrosis. Anti-rejection drugs given after the procedure suppresses the body’s immunity, which may cause the infection to spread easily to the transplanted lung. Widespread use of single lung transplant could increase the availability to donor organs to many patients.
Double or Bilateral Lung Transplantation – This transplantation procedure is associated with long-term advantage, which is a factor influencing the patient’s survival rate according to study conducted by surgeons at Johns Hopkins.
Heart-Lung Transplant – This medical procedure is advised to patients with severe pulmonary hypertensions where the heart disease affects the lung function.
Lobular Lung Transplantation – This procedure is becoming increasingly popular among critically ill patients who require immediate lung transplantation. It is a living lung transplantation where the lower lobes of the lungs are obtained from two living donors and transplanted to the recipient to provide normal lung functionality. This type of transplantation requires a thorough examination to determine the blood type and tissue match.
Breathing Lung Transplant – It is a cadaveric transplant where the lungs from the donor are kept in breathing state using an organ preservation system, Organ Care System, while the organ is transported to the recipient location. Conventionally the organs are transported in a non-functioning state in an ice-box. The first breathing lung transplant was successfully performed on a 57-year-old patient by surgeons at Ronald Reagan UCLA Medical.
With advancing technology, the survival rates following lung transplantation have drastically improved. It is estimated that 80% of the patients live for at least one year, while two out of five patients are alive after five years following the surgery. Most people experience an improved quality of life and have greater endurance to physical activities. Almost 40% of the patients get back to at least part-time jobs.
The risk of death during the first year is mainly due to organ rejection. Several anti-rejection medications like cyclosporine, tacrolimus, sirolimus, azathioprine, mycophenolate mofetil, Prednisone is being used to prevent tissue rejection. Within five years, nearly half the patients suffer chronic rejection due to acid reflux where gastric fluids enter the lungs and trigger the immune system to act against it. However, a recent research has shown that a treatment procedure could help prevent lung rejection.
Extensive research is being conducted to develop better treatment options and strategies to improve the survival rate among lung transplantation patients.
Written by: Janet Grace Ortigas