Type of Surgery
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Last updated: 02/17/2009
Patients who have diseases or conditions that may make them more susceptible to organ rejection are not selected for lung transplant. This includes patients who are acutely ill and unstable; have uncontrolled or untreatable pulmonary infection; significant...
dysfunction of other organs, particularly the liver, kidney, or central nervous system; and those with significant coronary disease or left ventricular dysfunction. Patients who actively smoke cigarettes or are dependent on drugs or alcohol may not be selected. There are a variety of protocols that are used to determine if a patient will be placed on a transplant recipient list, and criteria may vary depending on location.
The following diagnostic tests are usually performed to evaluate a patient for lung transplantation:
- Arterial blood gases (ABG) test, which measures the amount of oxygen that the blood is able to carry to body tissues.
- Pulmonary function tests (PFTs), which measure lung volume and the rate of air flow through the lungs; the results measure the progress of the lung disease.
- Radiographic studies (x rays). The most common is the chest x ray (CXR), which takes an internal picture of the chest including the lungs, ribs, heart, and the contours of the major vessels of the chest.
- Computerized tomography (CT) scan. A chest CT scan is taken of horizontal slices of the chest to provide detailed images of the structure of the chest.
- Ventilation perfusion scan (lung scan, V/Q scan) is a test that compares right and left lung function.
- Electrocardiogram (EKG) is performed by placing electrodes on the chest and one electrode on each of the four limbs. A recording of the electrical activity of the heart is obtained to provide information about the rate and rhythm of the heartbeat, and to assess any damage.
- Echocardiogram (ECHO) is an ultrasound of the heart, performed to evaluate the impact of lung disease on the heart. It examines the chambers, valves, aorta, and the wall motion of the heart. ECHO also provides information concerning the blood pressure in the pulmonary arteries. This information is required to plan the transplantation surgery.
- Blood tests. Blood samples are required for both routine and specialized testing.
In addition to tests and criteria for selection as a candidate for transplantation, patients are prepared by discussing at length the procedure, risks, and expected prognosis with the doctor. Patients should continue to follow all therapies and medications for treatment of the underlying disease, unless otherwise instructed by their physician. Since lung transplantation takes place under general anesthesia, patients are advised not to take food or drink from midnight before the surgery.
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Lung transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for end-stage pulmonary patients.
While the precise details of surgery will depend on the exact type of transplant, there are many steps which are common to all of these procedures. Prior to operating on the recipient, the transplant surgeon inspects the donor lung(s) for signs of damage or disease. If the lung or lungs are approved, then the recipient is connected to an IV line and various monitoring equipment, including pulse oximetry. The patient will be given general anesthesia, and a machine will breathe for him or her.
It takes about one hour for the pre-operative preparation of the patient. A single lung transplant takes about four to eight hours, while a double lung transplant takes about six to twelve hours to complete. A history of prior chest surgery may complicate the procedure and require additional time.
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