LUNG TRANSPLANTATION

General Information

DEFINITION--Replacement of diseased lungs with healthy lungs obtained immediately after death from a donor with compatible immunological characteristics. May involve one or both lungs.

BODY PARTS INVOLVED--Diseased or abnormal lungs; healthy donor lungs; blood vessels and bronchial tubes to the lungs.

REASONS FOR SURGERY--Pulmonary hypertension (See Glossary); respiratory failure; cystic fibrosis; bronchiectasis.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking; stress.
• Poor nutrition.
• Recent or chronic illness.
• Alcoholism.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs.

What To Expect

WHO OPERATES--Thoracic surgeon or cardiovascular surgeon with transplant experience and training.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Evaluation of body systems, especially the respiratory system; immune-system and lung-matching procedures.
• During surgery: Cardiac monitor.
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• Healthy lungs are removed from the donor, chilled and preserved up to 12 hours.
• An incision is made in the recipient's chest and the chest is spread apart.
• The heart-lung machine (See Glossary) sustains life during surgery.
• The lungs are cut free of the connecting bronchial tubes and blood vessels and removed.
• The donor lungs are positioned and sewn in place. Blood vessels and bronchial tubes are connected. Chest tubes remain for drainage.
• The chest muscles are closed. The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Pneumonia.
• Rejection of transplanted lung.

AVERAGE HOSPITAL STAY--3 weeks.

PROBABLE OUTCOME--When successful, a lung transplant prolongs life and improves the quality of life in patients who might otherwise have died. Allow about 6 months for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Stool softeners to prevent constipation. > Antibiotics to fight infection. > Immunosuppressants to decrease the likelihood of rejection.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 weeks after surgery. Ongoing exercise capability may be slightly limited. > Resume sexual relations when your doctor determines that healing is complete.

DIET---If needed, your doctor will prescribe a special diet.

Call Your Doctor If

Any of the following occur:

• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Signs of infection: fever, headache, muscle aches, dizziness or a general ill feeling.
• Nausea and vomiting.
• Unusual fatigue, coughing, shortness of breath or blood in the sputum.
• New, unexplained symptoms. Drugs used in treatment may produce side effects.