lungetransplantation

Lung transplantation is a surgical procedure in which a diseased lung is replaced with a healthy donor lung, usually from a deceased donor. The operation is considered for patients with end-stage pulmonary disease when other treatments have not provided adequate improvement. Transplants can be single-lung or double-lung; in some centers, living-donor lobar transplants are performed in selected cases.

Indications include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension, sarcoidosis, and other forms of end-stage lung disease. Contraindications vary by center but generally include active infection, active malignancy, irreversible dysfunction of other organs, significant nonadherence or psychosocial instability, ongoing substance abuse, extreme obesity, and smoking history that disqualifies the candidate.

Donor lungs are obtained from brain-dead donors and must be ABO compatible and appropriately sized for the recipient. Donor risk factors and ischemic time influence suitability, and matching aims to minimize graft injury and optimize function.

During surgery, the diseased lungs are removed and the donor lungs are connected to the recipient’s airways and blood vessels. Single-lung transplantation uses one donor lung, while double-lung transplantation uses both. Postoperative care requires lifelong immunosuppression to prevent rejection, typically with a calcineurin inhibitor (such as tacrolimus), an antiproliferative agent, and corticosteroids, along with infection and rejection prophylaxis.

Risks include primary graft dysfunction, infection, acute rejection, chronic rejection (bronchiolitis obliterans syndrome), anastomotic problems, bleeding, and medication-related complications. Outcomes have improved with advances in donor-recipient matching and post-transplant care; median survival is measured in several years, with meaningful improvements in symptoms and quality of life for many recipients.

Follow-up is lifelong and includes regular monitoring, vaccination, pulmonary rehabilitation, and adherence to immunosuppressive therapy.