Lung Transplantation,Selection of Donor and Recipient for Transplantation,Complications

Indication and patient selection for Lung Transplantation

patient under 60 years with a life expectancy of fewer than 18 months without transplantation, no underlying malignancy and no serious systemic disease.

Following diseases are treated by lung transplantation.

• Emphysema- smoking-induced or due to alpha- one antitrypsin deficiency.
• Idiopathic pulmonary fibrosis
• Cystic fibrosis
• Eisenmenger’s syndrome
• Primary pulmonary hypertension

Lung transplantation options

Single lung transplantation

• Emphysema
• Idiopathic pulmonary fibrosis
• Primary pulmonary hypertension

Bilateral lung transplantation

• Cystic fibrosis
• Emphysema
• Primary pulmonary hypertension
• Bronchiectasis

Living related lobar transplantation

• Cystic fibrosis
• Bilateral lower lobe transplantation from two Different living donors

Heart-lung transplantation

• Congenital heart diseases with Eisenmenger’s syndrome.
• Left ventricular failure and end-stage lung disease

Recipient selection For Lung Transplantation

The recipient should be a Patent under 60 years with end-stage lung disease, a life expectancy of fewer than 18 months without transplantation, no underlying malignancy and no serious systemic disease such as coronary artery disease, renal insufficiency, liver disease, osteoporosis and chronic unresolved infection. Abstinence from smoking should *be at least 6 months.

Donor selection For Lung Transplantation

Age under 40 years, good cardiac and lung function and chest measurement slightly smaller than those of recipient. ABO blood group is essential.

Complications of Lung Transplantation

•    Acute rejection: usually in the first 3 months presenting with dyspnea, fever and cough.
•    Chronic rejection in the form of bronchiolitis obliterans.
•    Infections, particularly within the first 3 months.
•    Complications of immunosuppressive therapy.
•    Recurrence of an underlying disease such as sarcoidosis.

Prognosis of Lung Transplantation

Two-year survival of 75% and 5- year survival almost 50%.