Advanced
Lung Transplant
Surgery in Hyderabad

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 Surgery Procedure

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.

The Lung Transplant Surgery Procedure

The Intraoperative stage of lung transplant surgery involves the actual removal of diseased 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 Procedure

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