Background

Lung transplant is treatment for advanced lung disease. Lung transplants save patients with end-stage lung disease unresponsive to alternative treatments. 

Lung transplantation improves the quality of life for patients with end-stage respiratory failure that does not respond to treatment. Dr. James Hardy performed first human lung transplant in 1963. 

Types of Lung Transplants as follows:  

Single-Lung Transplant 

Double-Lung Transplant 

Living donors provide lower lobes for bilateral implantation in transplantation. 

Criteria for donor lungs include: 

Donor age between 18 to 55 years old 

No history of smoking or minimal smoking history 

No significant lung disease/infection 

Blood type compatibility with the recipient 

Indications

Causes of respiratory failure in patients with advanced-stage pulmonary disease are as follows: 

Chronic Obstructive Pulmonary Disease 

Pulmonary Arterial Hypertension 

Sarcoidosis 

Bronchiectasis 

Idiopathic Pulmonary Fibrosis 

Cystic Fibrosis 

Interstitial Lung Diseases 

Contraindications

Absolute Contraindications as follows: 

Significant Cardiovascular Disease 

Active or Recent Malignancy 

Uncontrolled Infection 

Significant Liver or Kidney Dysfunction 

Active Substance Abuse 

Relative Contraindications as follows: 

Age and Body Mass Index 

Colonization with Resistant Organisms 

Mechanical Ventilation 

Outcomes

Lung transplant recipients have better one-year survival rates of 80% to 90%. Lung transplant recipients see increased survival rates post five years. 

Lung transplants improve quality of life for recipients with severe lung disease. Benefits include increased exercise capacity, reduced symptoms, and better ability to do daily tasks. 

Lung function improves after transplantation, but decline can occur due to rejection. 

Lung transplant patients experience enhanced exercise capacity and endurance for improved physical activity ability. 

Equipment

Surgical Instruments: 

Chest Tubes and Drainage Systems 

Anastomosis Equipment 

Anesthesia Equipment 

Monitoring Equipment 

Cardiopulmonary Bypass and ECMO Equipment 

Patient Preparation

Informed Consent:  

Educate patients and their family on procedure, risks, benefits, and post-transplant regimen importance. 

Patient Positioning:  

Patients receive general anesthesia, intubation, and mechanical ventilation during surgery. 

Patient positioned on side for single-lung transplant or back with arms extended for double-lung transplant. 

Donor Lung Harvesting: 

Donor lungs are removed and preserved before being transported to the transplant center for surgery. 

Fig. Anatomy of lung 

Technique

For Single-Lung Transplantation: 

Step 1: Excision of Diseased Lung 

Incision made on chest side between ribs for thoracotomy. 

Recipient’s diseased lung removed with careful dissection, clamps, and vessels cuts. 

Step 2: Implantation of Donor Lung 

The donor lung is placed in the chest cavity and connected through surgical connections as:  

The donor pulmonary artery connected to recipient, then donor pulmonary veins connected to recipient left atrium, and finally donor bronchus connected to recipients. 

Step 3: Reperfusion 

The transplanted lung receives blood flow and ventilation. Sutures or staples are used to close the chest, with chest tubes inserted for drainage. 

For Double-Lung Transplantation: 

Step 1: Excision of Diseased Lung 

Surgical incisions were made to access both lungs during medical procedures. 

Recipient undergoes bilateral lung removal surgery, with clamps and cutting of blood vessels. 

Step 2: Implantation of Donor Lung 

Donor lungs implanted sequentially with same anastomoses as single-lung transplantation. 

Step 3: Reperfusion 

The transplanted lung receives blood flow and ventilation. Sutures or staples are used to close the chest, with chest tubes inserted for drainage. 

Fig. Lung transplantation 

Complications

Early Complications as follows: 

Infection 

Primary Graft Dysfunction 

Acute and Hyperacute Rejection 

Late Complications as follows: 

Malignancies 

Cardiovascular Disease 

Renal Dysfunction 

Chronic Rejection  

References

Lung Transplantation – StatPearls – NCBI Bookshelf (nih.gov) 

References

Lung Transplantation – StatPearls – NCBI Bookshelf (nih.gov)