Contraindications
Not every patient who wants a lung transplant can be guaranteed a lung transplant. One reason for this is the lack of donor organs and there are certain contraindications for which lung transplantation should be avoided. One contraindication is for example blood poisoning (sepsis).
Lung transplantation is also refrained from in the case of a tumor in the lung, since life expectancy can hardly be increased. Chronic functional disorders of other organs, such as kidney failure or severe liver damage, can also be a contraindication. Probably the most serious contraindication is a disturbance of the nervous system or a severe mental illness.
Excessive consumption of drugs, alcohol or nicotine can also be a contraindication. Since a transplantation is always accompanied by immunosuppression, chronic infectious diseases are also a contraindication. If the patient is infected with a multi-resistant bacterium, e.g. MRSA, a lung transplantation can only be performed when the patient is germ-free.
Preparation time
A lung transplantation is always associated with a certain risk. In order to keep the risk as low as possible, the patient has to undergo a few tests before the transplantation. First of all, the thorax area is examined in detail using x-rays and computer tomography (CT).
After extensive lung function tests and examinations of the heart using echocardiography, the abdominal area must also be examined in detail using abdominal sonography. In addition, blood must be taken from the patient to rule out any tumor disease or infection. In addition, a right-heart catheter examination is also necessary, as the pressure conditions in the lungs must be analyzed.
In addition, a psychological expertise must always be provided, since a transplantation is always associated with a great deal of psychological stress. Once all these tests and examinations have been completed, the results are sent to a lung transplant center and a team of doctors then decides whether a transplant is necessary or how quickly the patient’s chance of a new lung should be realized. Since a lung is usually not immediately available, the patient must then come to the transplant center for a check-up every 3 months.
As soon as a suitable donor lung is available, the patient will be notified by the transplant center and should avoid further eating and drinking. Once the patient has arrived at the hospital, a decision will be made whether the lung can be transplanted or whether the patient must go home without a new lung. However, if a patient is transplanted, he or she is usually taken directly to the operating room and anesthesia is induced.
Usually both lungs are transplanted, since a lung transplantation of only one lung often results in severe infections of the “old” lung. In order to remove the lobes of the lungs, a cross-section is made in the thorax. Then the diseased lung is removed and the new donor lung is inserted.
First the pulmonary bronchi and pulmonary veins are connected to the new lung, and finally the pulmonary arteries. As soon as the blood can circulate again, the lung should start working. The incision is closed and the patient is first admitted to the intensive care unit.The stay in the intensive care unit should not be longer than one week, but in about 15% of all cases complications occur that lead to a longer intensive care stay.
In unproblematic cases, the stay in the intensive care unit is followed by a hospital stay of about 3 weeks, during which the patient receives intensive physiotherapeutic care. After the transplantation, the patient receives immunosuppressive medication to prevent a possible rejection of the lung. However, these drugs suppress the patient’s entire immune system.
Therefore, patients are more susceptible to fungal, viral or bacterial diseases after a lung transplantation. In order to keep these as low as possible, the patient receives additional medication to prevent a possible infection. This should also reduce the possible risks of infection and the patient now has the opportunity for a new, more carefree life.
