Adult bronchiolitis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Lung transplant is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with untreatable and advanced stage lung disease.
Indications
- Lung transplant is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with either:[1][2][3]
- Clinically severe disease where medical therapy is ineffective.
- The risk of death from lung disease without transplantation is more than 50% within two years
- The likelihood of surviving at least 90 days after lung transplantation is more than 80%
- Absence of a non-respiratory comorbidity that would limit life expectancy in the first 5 years after transplant
- Acceptable social profile and support system
Contraindications
- Absolute contraindications include the following:
- Uncontrolled or untreatable pulmonary or extrapulmonary infection
- Active TB infection
- Malignancy within previous 2 years
- Significant comorbidity of other vital organs
- Significant coronary heart disease not treated by revascularization
- Untreatable bleeding diathesis
- Significant chest wall or spinal deformity expected to cause severe restriction after transplantation
- Grade II or III obesity with body mass index (BMI) ≥35 kg/m2
- Smoker
- Drug or alcohol dependency
- Unresolved psychosocial problems or noncompliance with medications
- Relative contraindications include the following:
- Age more than 65 years in association with low physiologic reserve or other relative contraindications
- Grade I obesity with body mass index (BMI) 30 to 34.9 kg/m2
- Severe or progressive malnutrition
- Severe with clinical manifestations of osteoporosis
- Previous cardiothoracic surgery
- Colonization or infection with highly resistant or highly virulent agents
- HIV positive patient
- Active hepatitis B or C infection
- Absence of a consistent social support system
Medical tests for potential transplant candidates
Patients who are being considered for lung transplantation undergo the following tests to ensure lung transplant success and the patients' clinical status:[4]
- Blood typing:
- The blood type of the recipient must match that of the donor due to certain antigens that are present on donated lungs.
- A mismatch of blood type can lead to a strong response by the immune system and subsequent rejection of the transplanted organs
- Tissue typing:
- Ideally, the lung tissue would also match as closely as possible between the donor and the recipient, but the desire to find a highly compatible donor organ must be balanced against the patient's immediacy of need
- Chest X-ray
- To verify the size of the lungs and the chest cavity
- Pulmonary function tests
- Ventilation/perfusion (V/Q) scan
- Electrocardiogram
- Cardiac catheterization
- Echocardiogram
Types of lung transplant
Lobe
A lobe transplant is a surgery where a lobe or the entire diseased lung is replaced by a healthy donor lung.
Single-lung
A single lung is transplanted and the donor has usually been pronounced brain dead.
Double-lung
Certain patients may require both lungs to be replaced.
Surgery
Single-lung
- An incision is under the shoulder blade around the chest, ending near the sternum or an incision is made under the breastbone.
- The diseased lung is collapsed, the blood vessels are clamped and the lung is cut from the bronchus
- The donor lung is placed in the correct position and the blood vessels are reconnected.
- The lung is then reinflated.
- A bronchoscopy is performed to remove blood or mucus in the new lung.
Double-lung
- The procedure is similar to the one described above, but the process occurs twice, once for each lung.
- A less common alternative is the transplantation of both lungs en bloc or simultaneously.
Risks
- Signs of rejection:[5]
- Fever
- Flu-like symptoms, including:
- Chills
- Dizziness
- Nausea
- Lethargy
- Dyspnea
- Progressively worsening pulmonary function test
- Chest pain or tenderness
- In order to prevent transplant rejection and subsequent damage to the new lung or lungs, patients must take immunosuppressive drugs
- Patients will normally have to take a combination
- The immunosuppressive regimen starts just before or after surgery, including:
- Chronic rejection, may occur after the first years with repeated episodes of rejection symptoms.
- Chronic rejection occurs in approximately 50% of transplant patients.
Prognosis
Transplanted lungs on average last 3 to 5 years before showing signs of failure.
References
- ↑ Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, Lederer DJ, Mulligan MJ, Patterson GA, Singer LG, Snell GI, Verleden GM, Zamora MR, Glanville AR (January 2015). "A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation". J. Heart Lung Transplant. 34 (1): 1–15. doi:10.1016/j.healun.2014.06.014. PMID 25085497.
- ↑ McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH (November 2016). "Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant". J. Heart Lung Transplant. 35 (11): 1289–1294. doi:10.1016/j.healun.2016.05.029. PMID 27381675.
- ↑ McAnally KJ, Valentine VG, LaPlace SG, McFadden PM, Seoane L, Taylor DE (January 2006). "Effect of pre-transplantation prednisone on survival after lung transplantation". J. Heart Lung Transplant. 25 (1): 67–74. doi:10.1016/j.healun.2005.07.012. PMID 16399533.
- ↑ "Lung Transplant Evaluation: Required Tests". Cleveland Clinic. February 7 2003. Retrieved 2006-09-29. Check date values in:
|date=(help) - ↑ "Lung Transplant". Aetna intelihealth. January 30 2006. Retrieved 2006-09-29. Check date values in:
|date=(help)