What is Lung transplant surgery?
Lung transplant surgery is a highly specialized, life-saving procedure in which one or both diseased lungs are replaced with healthy donor lungs. It is most commonly used to treat patients with end-stage lung disease who no longer respond to medicines or other medical therapies. This advanced surgical method brings back the normal lung function and increased oxygen exchange that crucially improves both survival and quality of life.
The goal of lung transplant surgery is to replace completely damaged lungs with healthy donor organs. Improves breathing capacity, oxygen levels, and physical endurance. Increased daily functionality and overall quality of life in patients with chronic respiratory failure. Lung transplant surgery is considered when lung function declines to a critical level, affecting daily activities despite optimal medical management.
Indications for lung transplant
Common conditions leading to lung transplant are
- Chronic obstructive pulmonary disease (COPD) is progressive airflow limitation due to chronic bronchitis or emphysema.
- Idiopathic pulmonary fibrosis (IPF) is where there is scarring of lung tissue, causing stiffness and decreased oxygen exchange.
- Cystic fibrosis is a genetic problem that causes thick mucus buildup and recurrent infection in the lungs.
- Pulmonary hypertension is an elevated pressure in the pulmonary arteries leading to right-sided heart failure.
- Sarcoidosis or interstitial lung disease are inflammatory and fibrotic conditions that reduce the normal functioning of the heart.
Over the years, significant advancements have been made in lung transplant surgery and surgical techniques, organ preservation therapies, and immunosuppressive therapies.
Donors are typically retrieved from brain-dead individuals whose lungs remain healthy and viable. Living donor lobar transplantation is also possible in select cases, where two donors each provide a lung lobe.
The allocation of lungs depends on compatibility with blood group, donor-recipient size matching, severity of illness, urgency, overall health, and likelihood of benefit.
Types of lung transplants
- A single lung transplant is where one lung is replaced, and is the most preferred surgical technique for the treatment of pulmonary fibrosis or chronic obstructive pulmonary disease.
- A double lung or bilateral transplant is where both lungs are replaced, often necessary for cystic fibrosis or widespread lung infection.
- A heart-lung transplant is performed when both the heart and lungs are irreversibly damaged and require replacement. The choice of procedure depends on the underlying disease, patient suitability, and donor organ availability.
Introduction of minimally invasive thoracic surgery has greatly reduced recovery time and problems.
Robotic-assisted techniques enable greater accuracy in complex transplant procedures.
The development of novel immunosuppressants helps reduce rejection risks while reducing the side effects.
Ex vivo lung perfusion (EVLP) technology allows lungs to be examined and optimized before transplantation, which increases the number of donor usable organs.
| Procedure Name | Lung Transplant |
|---|---|
| Type of Surgery | Major thoracic transplant surgery |
| Type of Anesthesia | General anesthesia |
| Procedure Duration | Approximately 6 to 12 hours |
| Recovery Duration | Hospital stay is around 2 to 3 weeks. Initial recovery is usually 3 to 6 months; full recovery and return to normal activities typically occur within 6 to 12 months |
Lung Transplant: Pre-Op & Post-Op Care
Lung transplant surgery, like any other major transplant surgery, is divided into three main stages: pre-operative, intra-operative, and post-operative stages to ensure that the process is conducted safely and successfully. Pre-operative phase is about the examination of the patient and their preparation before the surgery. Intra-operative phase is where the actual process is performed on the patient under the influence of anesthesia, and the post-operative phase highlights recovery, monitoring, and long-term care for better results.
Before the start of the Lung Transplant
The pre-operative phase of lung transplant surgery depends on examination, improvement, and making the patient ready for the lung transplant procedure. It is to make sure that the patient is completely ready for surgery, physically and psychologically, and that a suitable donor is also available.
Patient assessment is done accurately to determine whether the patient is ready for transplant. Pulmonary examination of lung function makes use of spirometry, blood gas analysis, and diffusion capacity.
Cardiac evaluation is by echocardiography and right heart catheterization to check for pulmonary hypertension or cardiac dysfunction.
Infectious screening involves blood and sputum analysis, viral screening for diseases like HIV, Hepatitis B/C, cytomegalovirus, and Epstein-Barr virus.
Imaging studies, utilized for testing patients before lung transplant surgery, are mainly used to examine the pathology of the lung and vascular anatomy.
The health status of other organs, like the kidney, liver, and gut, is also examined to ensure that they are functioning normally.
Donors are matched and selected based on blood type compatibility, matching the size of lung volume and chest activity, and the absence of transmissible infections. Cross-matching and human leukocyte antigen typing are carried out to decrease the risk of organ rejection.
Once a suitable donor lung is obtained for lung transplant surgery, the transplant surgery is scheduled immediately to reduce the period of tissue, or organ, being deprived of a normal blood supply.
In the pre-operative stage itself, the patient is treated for any infections before the surgery. Patient is advised by specialists to practice some breathing exercises, restrictions in diet, and start physiotherapy in order to regain strength.
Vaccination is given to the patients for pneumococcal, influenza, and hepatitis diseases. Counseling is done on procedures, risks, prevention of lifelong immunity reactions, and follow-up protocols after the surgery.
Patient is also tested for proper anesthesia to determine the management of the airway and to make sure there are no underlying risks.
Intra-Operative Phase
lungs by surgery and implantation of donor lungs, under the influence of general anesthesia in a highly controlled environment.
The patient is placed under the influence of general anesthesia with a double-lumen endotracheal tube to allow ventilation in the other lung. The patient is continuously kept an eye on and their cardiac and respiratory status checked by using techniques like arterial line, central venous, pulmonary artery catheters, and transesophageal echocardiography.
During the surgery process, the lung that is not being operated on is ventilated, while the operative lung is deflated to provide a clear surgical field.
The approach to surgery depends on whether the lung transplant is a single-lung transplant or a double-lung transplant.
Single-lung transplant is done via posterolateral thoracotomy, and double-lung transplant is done by bilateral transverse thoracosternotomy incision.
The diseased lungs are carefully exposed while preserving other vital organs, and the diseased lung is cut from its pulmonary artery, pulmonary veins, and bronchus.
The donor lung implantation starts with connecting the recipient bronchi with the donor bronchi. This is followed by the surgeon connecting the pulmonary artery and pulmonary veins. All these connections are then carefully stitched together to make sure that they are completely sealed and prevent any type of air or fluid leakage.
The new lung is gradually reperfused with blood to check for leaks, bleeding, or dysfunction of grafts. Ventilation is restored, and oxygen levels are then closely observed.
Supportive techniques involving cardiopulmonary bypass (CPB) are used to maintain the patient’s oxygenation and hemodynamic stability during surgery. Extracorporeal membrane oxygenation (ECMO) can be used in high-risk cases as intraoperative or postoperative support.
After making sure that there is necessary ventilation and no bleeding, chest tubes are placed for drainage. The thoracic cut is then closed in layers.
The process of a single-lung transplant surgery takes 4-6 hours, and that of a double-lung transplant surgery takes 6-12 hours.
The duration of a lung transplant surgery typically varies based on complexity, patient stability, and the need for extracorporeal support.
After Lung Transplant Surgery
The post-operative phase focuses on the critical care management, monitoring of graft function, infection prevention, and patient rehabilitation.
Patients are initially kept in the intensive care unit and are closely observed with mechanical ventilation support for 24-72 hours to maintain levels of adequate oxygen levels.
Continuous hemodynamic monitoring is performed to keep track of blood pressure, cardiac output, and levels of oxygen in the blood.
Pain is effectively managed by making sure the epidural and intravenous analgesia are used to promote comfortable breathing.
Chest drains are monitored and removed once air leakage or fluid output has subsided.
Fluids and electrolytes are provided to the patient to make sure there is no case of pulmonary edema or rejection of the graft.
Imaging tests like computed tomography and chest X-rays are performed to evaluate lung expansion and detect if there are any problems after the procedure.
Patient assessment is done accurately to determine accurate lung function after transplant. Pulmonary examination of lung function makes use of spirometry, blood gas analysis, and diffusion capacity to examine oxygenation and levels of carbon dioxide.
Any issues after surgery, like primary graft dysfunction, infection, and rejection, are promptly managed using steroids, antibiotics, antivirals, and immunomodulatory therapy.
Rehab includes pulmonary exercises, gradual physical activity, and nutritional optimization to bring back complete lung functionality, capacity, and strength.
Long-term management includes regular follow-ups, modifications in lifestyle by avoiding smoking and alcohol, and psychological support to ensure the patient is healthy overall and leads a quality life.
Benefits of Lung Transplant at Yashoda Hospitals
- Improved breathing ability
- Enhanced oxygen levels
- Improved quality of life
- Better tolerance to exercise
- Extended life expectancy
- Relief from chronic symptoms
- Decreased dependency on medicines
- Restored lung function
- Improved mental and emotional health
- No recurrent lung infections
Appointment
Second Opinion
WhatsApp
Call
More
