Lung Transplantation

Introduction

The lung (pulmo) is used for gas exchange and breathing. Since it therefore fulfils vital tasks, a lung transplantation is only performed if no other therapy promises a cure. Strictly speaking, the lung consists of 2 lungs, one on the right and one on the left.

Depending on the severity and indication, one lung, both lobes of the lung or several lobes of the lung are removed in a lung transplantation and then the functional lung of a donor is inserted. Lung transplantation is only used in cases of advanced lung disease, since every transplant always involves a certain risk. It must therefore be ensured beforehand that all possible conservative therapies have not worked or no longer have any effect.

However, if the patient is already suffering from dyspnea at rest and his life expectancy without transplantation is less than 18 months, a transplantation will be performed. There are various clinical pictures for which a lung transplantation can be performed. These include, among others, the Other causes of lung transplantation can also be Langerhans cell histiocytosis (Histiocytosis X), lymphangioleiomyomatosis or bronchiolitis obliterans.

  • Muscoviscidosis (cystic fibrosis) with bilateral bronchiectasis
  • The idiopathic pulmonary fibrosis
  • A chronic obstructive pulmonary disease (COPD) with alpha-1-antitrypsin deficiency and
  • The pulmonary emphysema and
  • Pulmonary hypertension caused by heart defects and
  • Sarcoidosis.

However, it is important to know that none of these diseases mean that lung transplantation is necessary. Rather, the patient must be analyzed on the basis of his symptoms and laboratory values to determine whether a therapy with medication can still lead to success, whether the damage is too far advanced and healing is impossible or whether it still makes sense to transplant a new lung because the patient would gain several years of life. If, for example, a patient with cystic fibrosis has a relative one-second capacity of only 30% (FEV1=30%), this is definitely an indication for a lung transplantation.

However, in a patient with chronic obstructive lung disease, who also has a relative one-second capacity of 30%, it is possible that this patient does not require a lung transplant but can live well with the correctly adjusted medication. This example shows that lung transplantation always requires the consideration of many different factors and that there is no specific value above which one says that a transplant is absolutely necessary. However, there are some characteristics from when a lung transplantation should be considered. For example, a 6- or 12-minute walking test, in which the patient is asked to walk as far as he can in the time given. A patient who needs a lung transplantation is only about 500m behind in this time because he gets out of breath with the slightest effort.