1.
|
What are the selection
criteria for lung transplantation?
|
|
| The selection criteria, in general, are end stage plumonary parenchymal
or vascular disease with a projected life expectancy of less than two years. In addition,
the patient should be at a New York Heart Association functional level of at least class 3
or 4 but should have rehabilitation potential. Some of the specific diseases that are
considered for lung transplantation include: idiopathic pulmonary fibrosis, cystic
fibrosis, pulmonary hypertension (with symptoms), and emphysema (with a post
bronchodilator FEVI of less 25% predicted). |
|
NEXT Question | TOP
of Page | FAQs HOME | CTSNet HOME
|
2.
|
How are decisions made
about whether to implant a single lung, a double lung, or a heart/lung block?
|
|
| Some transplant candidates are only candidates for double lung
transplantation. These include those with pulmonary hypertension and septic lung disease
(cystic fibrosis, bronchiectasis, etc.). Heart/lung blocks are rarely done, and in our
practice we reserve this for end-stage lung disease combined with either irreparable
cardiac problems or end-stage cardiac dysfunction. Most lung transplants are single lung
transplants. Every attempt is made to perform single lung transplants which are
considerably less morbid for the recipient and allow maximum use of donor organs. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
3.
|
What kinds of lung
protection techniques are utilized?
|
|
| The optimal donor lung protection techniques are controversial and are
in a state of evolution. Currently, the most common protective solutions are solutions
used for other transplanted organs, such as Euro-Collins solution. However, recent
evidence suggests that low potassium-based solutions may be better than the high potassium
Euro-Collins. Other approaches in lung protection include ventilating the lungs until they
can be harvested, use of PGE1 to dilate the pulmonary vasculature during in fusion of
protective solutions, and optimal donor management that prevents the lungs from becoming
too wet during donor stabilization and harvesting. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
4.
|
What kind of donors are
suitable as lung donors?
|
|
| Donor selection is perhaps more important in the case of lung
transplantation than is most other organs. One reason for this need for selectivity is
that the lungs must work right away upon implantation because continuing a patient on ECMO
is a ver y morbid sequel to lung transplantation. On 100% oxygen the donor's PO2 should be
above 450 mm Hg. There should be no, or minimal physical injury to the lung trauma, such
as large penetrating wounds, or contusions. This determination should be made from x-ray
and history prior to opening the chest for harvest and the lung should be reinspected at
the time of procurement for such injuries. The sputum should be examined for contaminants.
If it is apparent that massive aspiration has occur red as evidence by food particles in
the secretions, these lungs will not be very good for transplantation. Similarly, if there
is heavy polymicrobial contamination of the airways these lungs will not be very good for
implantation, though many groups have used lungs with significant contamination. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
5.
|
What are the techniques for
managing the airways during re-implantation of the lungs?
|
|
| This used to be the Achilles heel of lung transplantation, but it now
appears that a great deal of the problem with bronchial dehiscence had to do with
preservation and techniques of anastomosis. Most surgeons implanting the lungs now use a
form of telescoping anastomosis, but even this may not be necessary for healing. The most
important issues in handling of the airways are: optimizing preservation, preserving all
possible arterial supply to the bronchi, and ensuring the sutures are p laced such that
they are deep on both donor and recipient bronchi. Similarly, the recipient bronchus
should be trimmed back to within one cartilaginous ring of the upper lobe takeoff. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
6.
|
How is rejection diagnosed
after implantation?
|
|
| Most patients will experience some episodes of rejection. The best
evidence of rejection is a change in the patient's ability to breath or be ventilated. The
chest x-ray as usual will be the best indicator other than the overall clinical picture .
The patients will often be somewhat hypoxic. They may have fevers. The transbronchial
biopsy can be helpful but not reliably diagnostic of rejection. Often, it is necessary to
treat the patient empirically for both rejection and infection, since many infections are
quite difficult to diagnose in their initial stages. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
7.
|
What is the early
management of the recipient?
|
|
| The recipients are treated with early extubation, scrupulous
management of their fluid status, and early mobilization. Their feeding should be advanced
very slowly since the vagus nerves may be impaired causing delayed gastric emptying, and
the new lung will not have any sensation and thus the patient may not be aware of
aspiration when is has occurred. Epidural catheters are used to enhance pain management
and aggressive physical therapy is provided. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
8.
|
Will there be any source of
donor lungs?
|
|
| The time may come when lungs from non-heart beating donors can be
utilized. Some other organs from these types of donors are already being utilized and some
research has shown that ventilating lungs after cardiac activity has ceased does allow so
me preservation while procurement could be undertaken. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
9.
|
Can lungs transplanted into
pediatric patients grow?
|
|
| This question is unanswered at the present time, but those involved in
the front lines of pediatric lung transplantation and research believe that they can
indeed grow. There is definitely evidence that there are dividing pneumocytes and it is
felt that both immature, and perhaps even mature, tissue transplanted into children can
actually create new air exchange units. |
| NEXT Question |
TOP of Page | FAQs HOME |
CTSNet HOME
|
10.
|
Will lobar transplantation
from living related donors ever become part of the donor supply?
|
|
| This is a question that was dealt with in the laboratory initially.
Clearly such transplants can be done experimentally. There are several groups that have
some experience in humans with some success. Living related lobar transplantation is
particularly attractive in the cystic fibrosis population. This is still investigational. |
| TOP of Page |
FAQs HOME | CTSNet HOME
|
Additional General Thoracic Surgery FAQs
|
|
|
|
