Adult bronchiolitis surgery: Difference between revisions

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*[[Lung transplantation|Lung transplant]] is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with either:<ref name="pmid25085497">{{cite journal |vauthors=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 |title=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 |journal=J. Heart Lung Transplant. |volume=34 |issue=1 |pages=1–15 |date=January 2015 |pmid=25085497 |doi=10.1016/j.healun.2014.06.014 |url=}}</ref><ref name="pmid27381675">{{cite journal |vauthors=McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH |title=Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant |journal=J. Heart Lung Transplant. |volume=35 |issue=11 |pages=1289–1294 |date=November 2016 |pmid=27381675 |doi=10.1016/j.healun.2016.05.029 |url=}}</ref><ref name="pmid16399533">{{cite journal |vauthors=McAnally KJ, Valentine VG, LaPlace SG, McFadden PM, Seoane L, Taylor DE |title=Effect of pre-transplantation prednisone on survival after lung transplantation |journal=J. Heart Lung Transplant. |volume=25 |issue=1 |pages=67–74 |date=January 2006 |pmid=16399533 |doi=10.1016/j.healun.2005.07.012 |url=}}</ref>
*[[Lung transplantation|Lung transplant]] is not the first-line treatment option for patients with adult bronchiolitis. Surgery is usually reserved for patients with either:<ref name="pmid25085497">{{cite journal |vauthors=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 |title=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 |journal=J. Heart Lung Transplant. |volume=34 |issue=1 |pages=1–15 |date=January 2015 |pmid=25085497 |doi=10.1016/j.healun.2014.06.014 |url=}}</ref><ref name="pmid27381675">{{cite journal |vauthors=McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH |title=Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant |journal=J. Heart Lung Transplant. |volume=35 |issue=11 |pages=1289–1294 |date=November 2016 |pmid=27381675 |doi=10.1016/j.healun.2016.05.029 |url=}}</ref><ref name="pmid16399533">{{cite journal |vauthors=McAnally KJ, Valentine VG, LaPlace SG, McFadden PM, Seoane L, Taylor DE |title=Effect of pre-transplantation prednisone on survival after lung transplantation |journal=J. Heart Lung Transplant. |volume=25 |issue=1 |pages=67–74 |date=January 2006 |pmid=16399533 |doi=10.1016/j.healun.2005.07.012 |url=}}</ref>
**Clinically severe disease where medical therapy is ineffective.  
**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 risk of death from lung disease without [[Organ transplant|transplantation]] is more than 50% within two years
**The likelihood of surviving at least 90 days after lung transplantation is more than 80%
**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
**Absence of a non-respiratory comorbidity that would limit life expectancy in the first 5 years after transplant
Line 22: Line 22:
**Malignancy within previous 2 years
**Malignancy within previous 2 years
**Significant comorbidity of other vital organs  
**Significant comorbidity of other vital organs  
**Significant coronary heart disease not treated by revascularization  
**Significant [[coronary heart disease]] not treated by [[revascularization]]
**Untreatable bleeding diathesis
**Untreatable [[Hemorrhagic diathesis|bleeding diathesis]]
**Significant chest wall or spinal deformity expected to cause severe restriction after transplantation
**Significant chest wall or spinal deformity expected to cause severe restriction after [[Organ transplant|transplantation]]
**Grade II or III obesity with [[body mass index]] (BMI) ≥35 kg/m2  
**Grade II or III obesity with [[body mass index]] (BMI) ≥35 kg/m2  
**Smoker
**Smoker
Line 32: Line 32:
**Age  more than 65 years in association with low physiologic reserve or other relative contraindications  
**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  
**Grade I obesity with [[body mass index]] (BMI) 30 to 34.9 kg/m2  
**Severe or progressive malnutrition
**Severe or progressive [[malnutrition]]
**Severe with clinical manifestations of osteoporosis  
**Severe with clinical manifestations of [[osteoporosis]]
**Previous cardiothoracic surgery
**Previous [[cardiothoracic surgery]]
**Colonization or infection with highly resistant or highly virulent agents
**Colonization or infection with highly resistant or highly virulent agents
**[[Human Immunodeficiency Virus (HIV)|HIV]] positive patient
**[[Human Immunodeficiency Virus (HIV)|HIV]] positive patient
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===Medical tests for potential transplant candidates===
===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:<ref name="lung3">{{cite web |date=February 7 2003 |url=http://www.clevelandclinic.org/health/health-info/docs/2700/2720.asp?index=4491 |title=Lung Transplant Evaluation: Required Tests |publisher=Cleveland Clinic |accessdate=2006-09-29}}</ref>
Patients who are being considered for  lung transplantation undergo the following tests to ensure lung transplant success and the patients' clinical status:<ref name="lung3">{{cite web |date=February 7 2003 |url=http://www.clevelandclinic.org/health/health-info/docs/2700/2720.asp?index=4491 |title=Lung Transplant Evaluation: Required Tests |publisher=Cleveland Clinic |accessdate=2006-09-29}}</ref>
*Blood typing:
*[[Blood typing]]:
**The blood type of the recipient must match that of the donor due to certain [[antigen]]s that are present on donated lungs.
**The [[blood type]] of the recipient must match that of the donor due to certain [[antigen]]s that are present on donated lungs.
**A mismatch of blood type can lead to a strong response by the [[immune system]] and subsequent [[transplant rejection|rejection of the transplanted organs]]
**A mismatch of blood type can lead to a strong response by the [[immune system]] and subsequent [[transplant rejection|rejection of the transplanted organs]]
*Tissue typing:
*Tissue typing:

Latest revision as of 13:39, 5 April 2018

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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]

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]
  • 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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ "Lung Transplant Evaluation: Required Tests". Cleveland Clinic. February 7 2003. Retrieved 2006-09-29. Check date values in: |date= (help)
  5. ↑ "Lung Transplant". Aetna intelihealth. January 30 2006. Retrieved 2006-09-29. Check date values in: |date= (help)
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