The lungs represent a vital organ responsible for gas exchange in the body. However, certain diseases and medical conditions can limit its function so irreparably that transplantation with a donor organ becomes necessary. Lung transplantation carries numerous opportunities and benefits, but also risks that should not be ignored.
What is lung transplantation?
Depending on the nature of the condition and the degree of damage, a transplant involves replacing one wing, both wings, or individual lobes of the lung. The goal of the surgery is to restore proper gas exchange that has been disrupted. The lung is a complex organ. It can be differentiated into the left and right lung lobes. Depending on the nature of the symptoms and the degree of damage, transplantation involves replacing one lung, both lungs or individual lobes of the lung. The goal is to replace the no longer functional tissue with a healthy organ so that vital processes can continue and the patient’s life can be saved. Before a lung transplant can be used, however, the disease must already be far advanced and no longer treatable by drugs and other therapies. On the one hand, donor organs are in short supply, and on the other hand, the risks of a lung transplant outweigh the benefits in less severe cases. The basis is a detectable respiratory distress of the patient as well as a life expectancy that is less than 18 months without a donor organ. Damage to the tissue is caused by various diseases. These include, for example, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease or pulmonary hypertension. However, lung transplantation is considered a last resort for any disease.
Function, effect, and goals
Before transplantation can take place, many patients have often already endured a long ordeal, consisting primarily of the waiting list. Who receives one of the limited donor lungs and who does not depends on numerous factors and tests. These include, for example, the patient’s age and general health. If the transplantation has been approved, the first step before the operation is the preparation period. The aim of this phase is to make the individual risk of the person concerned as small as possible. For this purpose, the thoracic region is examined by X-rays and a CT scan. There are lung function tests as well as examinations of the heart. In order to exclude the presence of tumors and infections, a laboratory examination of the blood is also performed. The preparation period is completed by a psychological evaluation, if a transplantation represents an emotional burden. Based on the documentation, a decision is finally made as to the time frame within which the operation should take place. If a suitable donor organ could be found, the operation is initiated immediately. In most cases, transplantation of both lungs occurs. The operation of only one can cause a serious infection. To remove the tissue, an incision is first made in the thorax. Through the opening, the diseased part can be removed and the healthy organ can be inserted. First, the doctors connect the pulmonary bronchi and pulmonary veins, then the pulmonary arteries. Once the blood is able to circulate again, the new lung begins to function. If the transplantation could be completed successfully, the tissue is sutured. After completion of the operation, the patient must initially stay in the intensive care unit. Usually, the aim is to transfer the patient to another ward within a week. However, about 15 percent of all lung transplants experience complications that require a longer stay in the intensive care unit. Transplantation is accompanied by a 3 week hospital stay with rehabilitation. Patients must take medications to prevent the organism from rejecting the new lung. The aim of the operation is to restore the proper functioning of the disturbed gas exchange. If the operation could be completed successfully, the body again succeeds in supplying the cells with optimal oxygen and at the same time excreting the waste products produced.
Risks, side effects and dangers
As with any surgery, health risks arise during lung transplantation. These are already caused by the anesthesia.This means that complaints such as thrombosis or infections cannot be ruled out. Unclean sutures can lead to leaks and bleeding into the tissue. Studies have also shown that about 30 percent of all patients experience an acute rejection process of their body at least once during their lifetime with the new lung. This involves inflammation because the organism does not recognize the new tissue as the body’s own cells. Instead, it produces antibodies to destroy the supposed foreign body. These attack the lungs, and inflammation develops. Patients notice the reaction through fever, a dry mouth, impaired function of the organ, fatigue and shortness of breath. Treatment with antibiotics and immunosuppressants often eliminates the phenomenon. Particularly in the first year after surgery, patients also complain more often of infections with viruses, fungi and bacteria. The decisive factor for the frequent occurrence is the weakened immune system. This makes it easier for pathogens to penetrate the body and cause disease. Lung transplantation can cause respiratory complications. These are often based on narrowed airways, which in turn are based on the sutures. However, medical procedures now exist that have reduced the incidence of such complaints. These include, for example, stents, which the body degrades after some time, or small balloons. To ensure that the numerous possible risks can be detected at an early stage, regular check-ups are essential. In these, patients have blood drawn, the function of the lungs is tested, and the external appearance of the bronchial tubes is looked at.