Lung transplantation, or pulmonary transplantation, is a surgical procedure in which one or both lungs are replaced by lungs from a donor. Donor lungs can be retrieved from a living or deceased donor. A living donor can only donate one lung lobe. With some lung diseases, a recipient may only need to receive a single lung. With other lung diseases such as cystic fibrosis, it is imperative that a recipient receive two lungs. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for those with end stage pulmonary disease.
Qualifying conditions Lung transplantation is the therapeutic measure of last resort for patients with end-stage lung disease who have exhausted all other available treatments without improvement. A variety of conditions may make such surgery necessary. The most common indications for a lung transplant are pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and pulmonary vascular disease including pulmonary hypertension or pulmonary arterial hypertension.
Contraindications Despite the severity of a patient's respiratory condition, certain pre-existing conditions may make a person a poor candidate for lung transplantation. Absolute contraindications for undergoing a lung transplant include:
Patient refusal to undergo a lung transplant Cancer with a high risk of recurrence or death Chronic kidney disease with a glomerular filtration rate less than 40 or being on dialysis (unless also being considered for a kidney transplant) Acute kidney failure Acute coronary syndrome or heart attack in the last 30 days Stroke in the last 30 days Liver cirrhosis (unless also being considered for a concomitant liver transplant) Acute liver failure Septic shock Active infection outside the lungs Active tuberculosis HIV with a detectable viral load. Active hepatitis B and C are relative contraindications to lung transplantation and increase the risk of complications, including when liver fibrosis is present. However, hepatitis C patients are receiving transplanted lungs if the disease is controlled or cured. Similarly, those with HIV and an undetectable viral load can undergo a lung transplant routinely. Similarly, those with HIV can receive donor lungs infected with HIV. People who have had a hepatitis B vaccine can receive hepatitis B infected donor lungs and those without hepatitis C can receive hepatitis C infected lungs and then undergo antiviral therapy to cure the hepatitis C. Debility with limited recoverability during post-transplant rehabilitation Progressive cognitive impairment, such as dementia History of non-adherence to medical therapies Active substance use or substance use disorder, including tobacco smoking, vaping, or intravenous drug use Other severe and uncontrolled medical conditions that are expected to limit post-transplant survival Candidates for lung transplantation are selected and assessed by a medical team including pulmonologists, transplant surgeons, primary care physicians, pulmonary rehabilitation specialists. Generally, to be considered for a lung transplant, a candidate has to have an estimated risk of dying from lung disease greater than 50% within 2 years, and a likelihood of being alive in the period after a transplant of at least 80%.
History
The history of organ transplants began with several attempts that were unsuccessful due to transplant rejection. Animal experimentation by various researchers, including Vladimir Demikhov and Henry Metras, during the 1940s and 1950s first demonstrated that the procedure was technically feasible. James Hardy of the University of Mississippi performed the first human lung transplant on June 11, 1963. Following a single-lung transplantation, the patient, identified later as convicted murderer John Richard Russell, survived for 18 days. From 1963 to 1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing (i.e. reconnection of Bronchial passages). It was only after the invention of the heart-lung machine, coupled with the development of immunosuppressive drugs such as ciclosporin, that organs such as the lungs could be transplanted with a reasonable chance of patient recovery. The first successful transplant surgery involving the lungs was a heart-lung transplant, performed by Dr. Bruce Reitz of Stanford University in 1981 on a woman who had idiopathic pulmonary hypertension. Subsequent advances in the 1980s led to the first single and double lung transplants by thoracic surgeon Joel Cooper. Cooper completed the first successful long-term single lung transplant in 1983 (in patient Tom Hall), the first successful long-term double lung transplant in 1986 (in Ann Harrison) and the first successful long-term double lung transplant for a person with cystic fibrosis in 1988. In 1988, Vera Dwyer, a woman from County Sligo in Ireland, was diagnosed with an irreversible, chronic and fibrotic lung disease. Later on that year, she received a single lung transplant in the UK. In November 2018, Ms. Dwyer was recognized as the world's longest surviving single lung transplant recipient in an event at the Mater Hospital in Dublin. She died in 2021, thirty-three years after her transplant. In 2021, the team at Cedars-Sinai in Los Angeles, California completed the world's first robotic lung transplant, allowing a minimally invasive approach to the procedure. The first lung transplant completed by James Hardy was commemorated in the American Innovation dollar Mississippi coin in 2023.
Transplant requirements
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