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Lung Transplant

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💡 Key Point: Lung transplantation is life-saving for end-stage lung disease but carries high risks of infection, rejection, and long-term complications due to lifelong immunosuppression.

📖 About

Procedure involves replacing one or both diseased lungs with donor lungs.
Performed as single or double lung transplants depending on the underlying condition.
Generally offered to patients <60 years, though exceptions exist.
Requires lifelong immunosuppression (Ciclosporin, Tacrolimus, Steroids, Mycophenolate, Azathioprine, anti-lymphocyte globulin).
Immunosuppression ➝ 🚨 high risk of opportunistic infections.

🫁 Types

Single Lung Transplant: Used in conditions with infection risk confined to one lung (e.g. COPD, IPF).
Double Lung Transplant: Both lungs replaced (sequentially). Preferred in Cystic Fibrosis, IPF, Pulmonary Hypertension.

Lung Transplant Illustration

🎯 Indications

Cystic Fibrosis (➡️ DOUBLE).
Emphysema & Alpha-1 antitrypsin deficiency.
Idiopathic Pulmonary Fibrosis.
Advanced COPD.
Connective tissue–related pulmonary fibrosis.
Chronic Hypersensitivity Pneumonitis.
Advanced Sarcoidosis.
Primary Pulmonary Hypertension (➡️ DOUBLE).
Rare diseases: Langerhans cell granulomatosis, Lymphangioleiomyomatosis.

⚠️ Complications

Infections: CMV, Aspergillus, PJP; risk highest if donor seropositive & recipient seronegative.
Acute Rejection: Weeks–months; managed by ↑ immunosuppression.
Chronic Rejection: Bronchiolitis Obliterans Syndrome (BOS) ➝ progressive breathlessness & airflow limitation.
Drug Toxicity: Calcineurin inhibitors ➝ nephrotoxicity & hypertension.
Malignancy: Skin cancers & post-transplant lymphoproliferative disorder (PTLD).
GI Side Effects: Nausea, diarrhoea, peptic ulcer disease.

🩺 Post-Transplant Care

📈 Monitor lung function (spirometry, imaging) for early rejection.
🔬 Screen for infections (CMV, PJP, Aspergillus).
💊 Prophylaxis: TMP-SMX (Bactrim) for PJP, antivirals if indicated.
🏃‍♂️ Pulmonary rehab for recovery & QoL.
⚖️ Regular drug-level monitoring to balance efficacy vs toxicity.
📢 Patient education: adherence, infection precautions, recognising rejection.

📊 Prognosis

Median survival: 5–7 years, though some survive much longer.
Better outcomes: Younger patients, double lung transplants, cystic fibrosis.
Chronic rejection (BOS) ➝ leading cause of late mortality.
Careful monitoring improves QoL and prolongs survival.

📚 References

3 Clinical Cases — Lung Transplantation 🫁🔄

Case 1 — End-stage COPD 🚬: A 62-year-old man with GOLD stage 4 COPD, FEV₁ 22% predicted, on long-term oxygen therapy, presents with worsening breathlessness despite maximal inhaler therapy and pulmonary rehab. Multiple admissions in past year. Teaching: COPD is the commonest indication for lung transplant worldwide. Candidates are selected when prognosis is poor and quality of life severely impaired despite optimal treatment. Typically offered a single lung transplant if age/fitness appropriate.
Case 2 — Idiopathic Pulmonary Fibrosis 🌫️: A 55-year-old woman with rapidly progressive IPF (FVC 38% predicted, DLCO 30%) is hypoxaemic at rest and desaturates with exertion. She is referred early for transplant assessment. Teaching: IPF carries the worst prognosis of the interstitial lung diseases. Double lung transplantation is usually performed, as single lung grafts are at higher risk of infection and poor long-term function.
Case 3 — Cystic Fibrosis 🧬: A 28-year-old woman with CF and chronic Pseudomonas colonisation has severe bronchiectasis, FEV₁ 18% predicted, and recurrent haemoptysis requiring embolisation. She is cachectic despite nutritional support. Teaching: Bilateral lung transplantation is the only curative option in advanced CF. It removes the diseased lungs and associated reservoir of infection. Post-op care requires aggressive immunosuppression and infection prophylaxis.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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