General
Lung transplantation:
Indication and graft survival:
Lung and heart-lung transplant recipients have a high risk of infection originating from exposure to a non sterile environment and the extinguished cough mechanisms after transplantation. One-year patient survival time is more than 70%. Lung transplantation is indicated for patients with diffuse parenchyma lung disease, e.g. certain cases of cystic fibrosis. If any irreversible cardiac abnormalities are also present, heart-lung transplantation has to be performed. Procedures are single lung, double lung and combined heart-lung transplantation.
Donor selection and preservation:
Optimal donors should be less than 40 years old, nonsmoker, normal blood gases on ventilator support and an x-ray without consolidation. Preservation procedures are still discussed and investigated. Currently, cold crystalloid solution is used for storage of the cadaveric lung allowing for a maximum preservation time of 6 hours.
Transplant procedures:
Heart-lung transplantation is performed by a median sternotomy with aortic and right arterial anastomosis. Single lung transplantation is a straightforward surgical procedure. Double lung placement requires a close match for thoracic size and more elaborate surgical reconstruction of vessels and airways. Double lung and also heart-lung transplantation demand cardiopulmonary bypass with systemic anticoagulation.
Complications:
Acute rejection is quite common, but can be reduced by intensive treatment with high dosage corticosteroids and ATG or OKT3. Decreased lung function parameters demonstrate acute rejection in the early transplant period. Bronchial stenosis are common complications of the late transplant period treated with dilatation or stent placement. Chronic rejection is characterized by slowly progressive airway construction with also a decline in lung function parameters.
