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Is it possible to have one lung. Pneumonectomy: Living with One Lung – A Comprehensive Guide

by alexxlab

Can you survive with just one lung. How is a pneumonectomy performed. What are the risks and recovery expectations for lung removal surgery. Who might need a pneumonectomy and why.

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Understanding Pneumonectomy: The Surgical Removal of a Lung

A pneumonectomy is a major surgical procedure that involves the removal of an entire lung. This operation is typically performed when other less invasive treatments are not sufficient to address severe lung conditions. But how exactly is this complex surgery carried out?

During a traditional pneumonectomy, the surgeon makes an incision on the side of the patient’s body, carefully cuts through muscle tissue, and spreads the ribs to access the lung. The affected lung is then surgically removed, leaving the pleural space (the sac that contained the lung) initially filled with air, which is gradually replaced by fluid over time.

In some cases, particularly for early-stage tumors located near the lung’s outer surface, a less invasive technique called Video-Assisted Thoracoscopic Surgery (VATS) may be employed. This method utilizes a special camera (thoracoscope) and requires smaller incisions, potentially leading to faster recovery times. However, VATS pneumonectomy is a highly specialized procedure that demands exceptional surgical skill and experience.

The Necessity of Lung Removal: When is a Pneumonectomy Required?

While the prospect of living with one lung may seem daunting, there are several medical conditions that may necessitate this drastic measure. The most common reason for a pneumonectomy is lung cancer, particularly when the tumor is large or centrally located, making partial lung removal insufficient to eradicate the disease.

Other conditions that might require a pneumonectomy include:

  • Severe traumatic lung injuries
  • Advanced pulmonary tuberculosis
  • Persistent fungal infections of the lung
  • Bronchiectasis (a condition where the airways of the lungs become abnormally widened)
  • Certain congenital lung diseases
  • Bronchial blockage resulting in a destroyed lung
  • Pulmonary metastases (cancer that has spread to the lungs from another part of the body)

In each of these cases, the decision to perform a pneumonectomy is made after careful consideration of the patient’s overall health, the extent of lung damage, and the potential benefits versus risks of the procedure.

Navigating the Risks: Potential Complications of Pneumonectomy

While many patients who undergo a pneumonectomy recover successfully, it’s crucial to understand that this is a high-risk surgery with potential complications. What are some of the risks associated with lung removal surgery?

  • Respiratory failure
  • Pulmonary embolism (blood clot in the lung)
  • Pneumonia
  • Shock
  • Anesthesia-related complications
  • Excessive bleeding
  • Abnormal heart rhythms
  • Reduced blood flow to the heart

The likelihood of experiencing these complications can vary based on factors such as age, overall health, and the presence of other medical conditions. It’s important for patients to have a thorough discussion with their healthcare provider about their individual risk profile before proceeding with the surgery.

Preparing for Pneumonectomy: Essential Steps for Patients

Proper preparation is key to optimizing the chances of a successful pneumonectomy and smooth recovery. What steps should patients take to get ready for lung removal surgery?

  1. Provide a comprehensive list of all medications, including over-the-counter drugs, prescription medicines, herbs, vitamins, and supplements. Some medications, particularly blood thinners, may need to be discontinued before surgery.
  2. Quit smoking. This is crucial for improving lung function and reducing the risk of complications.
  3. Disclose any allergies, including latex sensitivity, to the healthcare team.
  4. Inform the anesthesiologist of any previous reactions to local or general anesthesia.
  5. Engage in a daily exercise routine as recommended by the healthcare provider to improve overall fitness before surgery.
  6. Practice breathing exercises using a spirometer to strengthen lung function.
  7. Fast from midnight before the day of surgery, unless otherwise instructed.

Additionally, patients may need to undergo several preoperative tests to ensure they are fit for surgery and to help guide the surgical plan. These may include:

  • Chest X-rays and CT scans
  • Positron Emission Tomography (PET) scan
  • Electrocardiogram (ECG)
  • Pulmonary function tests
  • Ventilation-perfusion scan
  • Blood tests

The Pneumonectomy Procedure: What to Expect During Surgery

Understanding the surgical process can help alleviate anxiety and prepare patients mentally for the procedure. How is a pneumonectomy typically performed?

The most common approach involves the following steps:

  1. Administration of general anesthesia to ensure the patient is unconscious and pain-free throughout the procedure.
  2. Positioning of the patient on their side to provide optimal access to the affected lung.
  3. Creation of an incision on the side of the chest, usually between the ribs.
  4. Careful separation of the ribs to expose the lung.
  5. Meticulous dissection of the lung from surrounding structures, including blood vessels and airways.
  6. Removal of the entire lung.
  7. Closure of the bronchus (airway) leading to the removed lung.
  8. Placement of chest tubes to drain any accumulated fluid or air.
  9. Closure of the incision with sutures or staples.

The duration of the surgery can vary but typically ranges from 2 to 4 hours. Following the procedure, patients are closely monitored in a recovery area before being transferred to a hospital room for further care and observation.

Life After Pneumonectomy: Adapting to a New Normal

One of the most common concerns for patients facing a pneumonectomy is how they will manage with only one lung. Is it truly possible to live a normal life after having a lung removed?

Remarkably, many individuals can indeed adapt to life with a single lung. The human body has a remarkable capacity for compensation, and the remaining lung often enlarges over time to increase its functional capacity. While some patients may experience reduced exercise tolerance or increased breathlessness with certain activities, many are able to return to a relatively normal lifestyle with appropriate rehabilitation and support.

However, it’s important to note that the recovery process can be lengthy and challenging. Patients typically spend several days in the hospital following surgery and may require weeks or even months of rehabilitation to regain strength and adapt to their new respiratory status. The area near the incision may remain painful for some time, and overall activity levels may be limited for 1 to 2 months post-surgery.

For individuals with pre-existing lung conditions such as emphysema or chronic bronchitis, the adjustment may be more difficult, and they may experience increased shortness of breath with certain activities. However, with proper medical management, pulmonary rehabilitation, and lifestyle adjustments, many patients can achieve a good quality of life following pneumonectomy.

Long-Term Considerations: Managing Life with One Lung

While adapting to life with a single lung is possible, it does require ongoing attention to health and lifestyle factors. What long-term considerations should pneumonectomy patients keep in mind?

  • Regular follow-up appointments with healthcare providers to monitor lung function and overall health.
  • Adherence to a tailored exercise program to maintain cardiovascular fitness and respiratory function.
  • Strict avoidance of smoking and exposure to secondhand smoke.
  • Prompt treatment of respiratory infections to prevent complications.
  • Maintenance of a healthy diet and weight to reduce strain on the respiratory system.
  • Consideration of vaccinations against influenza and pneumococcal disease to protect the remaining lung.
  • Potential need for supplemental oxygen during air travel or at high altitudes.
  • Awareness of increased susceptibility to respiratory issues and the importance of seeking medical attention for new or worsening symptoms.

By prioritizing lung health and working closely with their medical team, many pneumonectomy patients can lead fulfilling lives and engage in a wide range of activities, albeit with some modifications and precautions.

Advances in Pneumonectomy: Emerging Techniques and Future Prospects

As medical science continues to advance, new techniques and technologies are being developed to improve the outcomes of pneumonectomy procedures. What are some of the latest innovations in lung removal surgery?

One significant development is the increasing use of robotic-assisted surgery for pneumonectomies. This approach combines the benefits of minimally invasive surgery with enhanced precision and control for the surgeon. Robotic systems allow for three-dimensional visualization and greater maneuverability in tight spaces, potentially leading to reduced trauma, faster recovery times, and improved outcomes for suitable candidates.

Another area of research focuses on lung volume reduction techniques that may serve as alternatives to full pneumonectomy in some cases. These procedures aim to remove only the most damaged portions of the lung, preserving as much healthy tissue as possible. While not suitable for all patients who might otherwise require a pneumonectomy, these techniques show promise in improving lung function and quality of life for select individuals with severe emphysema or other chronic lung diseases.

Researchers are also exploring the potential of artificial lung technologies. While still in the experimental stages, these devices could potentially provide temporary or even long-term support for patients with severe lung dysfunction, potentially reducing the need for pneumonectomy in some cases or supporting patients post-surgery.

As our understanding of lung biology and regenerative medicine advances, there is also hope for future therapies that could stimulate lung regeneration or even create bioengineered lung tissue for transplantation. While these technologies are still in their infancy, they represent exciting possibilities for the future of lung disease treatment.

The Role of Multidisciplinary Care in Pneumonectomy

The complexity of pneumonectomy and its potential impact on multiple body systems underscores the importance of a multidisciplinary approach to care. How does a team-based approach benefit pneumonectomy patients?

A comprehensive care team for pneumonectomy typically includes:

  • Thoracic surgeons who perform the procedure
  • Pulmonologists to assess and manage lung function
  • Anesthesiologists specialized in thoracic procedures
  • Oncologists (for cancer patients)
  • Respiratory therapists to assist with breathing exercises and rehabilitation
  • Physical therapists to help with mobility and strength recovery
  • Nutritionists to ensure optimal nutrition for healing and long-term health
  • Mental health professionals to address psychological aspects of recovery
  • Specialized nurses trained in post-operative care for thoracic surgery patients

This collaborative approach ensures that all aspects of the patient’s health are considered before, during, and after the pneumonectomy. It allows for comprehensive preoperative evaluation, coordinated surgical planning, and tailored post-operative care and rehabilitation. The result is often improved patient outcomes, reduced complications, and better long-term quality of life for those undergoing this major surgical procedure.

Psychological Impact and Support for Pneumonectomy Patients

While much attention is rightly given to the physical aspects of pneumonectomy, the psychological impact of losing a lung should not be underestimated. How does lung removal surgery affect patients mentally and emotionally?

Many patients undergoing pneumonectomy experience a range of emotions, including:

  • Anxiety about the surgery and its outcome
  • Fear of living with reduced lung capacity
  • Grief over the loss of a body part
  • Concerns about changes in body image
  • Worry about the impact on lifestyle and future activities
  • Depression related to the underlying condition necessitating surgery

Addressing these psychological aspects is crucial for overall recovery and well-being. Support strategies may include:

  1. Pre-surgical counseling to prepare patients mentally for the procedure and recovery process
  2. Connection with support groups or mentors who have undergone similar surgeries
  3. Ongoing psychological support during the recovery period
  4. Family therapy to help loved ones understand and support the patient’s needs
  5. Mindfulness and relaxation techniques to manage stress and anxiety
  6. Cognitive-behavioral therapy to address any negative thought patterns or coping mechanisms

By integrating psychological support into the overall care plan, healthcare providers can help pneumonectomy patients navigate the emotional challenges of their journey, fostering resilience and promoting a positive outlook on life after surgery.

Pneumonectomy in Special Populations: Considerations and Challenges

While pneumonectomy is a complex procedure for any patient, certain populations may face unique challenges or require special considerations. How does the approach to pneumonectomy differ for various patient groups?

Elderly Patients: Older individuals may have reduced physiological reserves and a higher risk of complications. Careful preoperative assessment of cardiovascular health, cognitive function, and overall frailty is crucial. Minimally invasive techniques may be preferred when feasible to reduce surgical stress.

Pediatric Patients: Pneumonectomy in children presents unique challenges due to ongoing growth and development. Long-term effects on chest wall development and potential scoliosis must be considered. Specialized pediatric surgical and support teams are essential.

Patients with Chronic Obstructive Pulmonary Disease (COPD): These individuals may already have compromised lung function, making the loss of a lung particularly challenging. Extensive preoperative pulmonary rehabilitation and careful patient selection are critical.

Immunocompromised Patients: Those with weakened immune systems due to conditions like HIV or ongoing chemotherapy face higher risks of postoperative infections. Stringent infection control measures and prophylactic treatments may be necessary.

Patients with Multiple Comorbidities: Individuals with concurrent heart disease, diabetes, or other chronic conditions require a carefully balanced approach to manage all aspects of their health throughout the surgical process.

By tailoring the surgical approach, preoperative preparation, and postoperative care to the specific needs of these diverse patient groups, healthcare teams can optimize outcomes and provide the best possible care for all pneumonectomy candidates.

Pneumonectomy | Johns Hopkins Medicine

What is a pneumonectomy?

A pneumonectomy is a type of surgery to remove one of your lungs because of cancer, trauma, or some other condition.

You have two lungs: a right lung and a left lung. These lungs connect to your mouth through a series of tubes. Through these tubes, the lungs bring oxygen into the body and remove carbon dioxide from the body. Oxygen is necessary for all functions of your body. Carbon dioxide is a waste product that the body needs to get rid of. Most people can get by with only one lung instead of two, if needed. Usually, one lung can provide enough oxygen and remove enough carbon dioxide, unless the other lung is damaged.

During a pneumonectomy, the surgeon makes a cut (incision) on the side of your body. The surgeon cuts some muscle and spreads the ribs apart. He or she surgically removes the affected lung. The sac that contained the lung (pleural space) fills up with air. Eventually, fluid takes the place of this air.

In rare cases, healthcare providers may do a pneumonectomy with a VATS procedure instead. This procedure uses a special video camera called a thoracoscope. It is a type of minimally invasive surgery. That means it uses smaller incisions than the traditional open surgery done on the lung. In cancer treatment, most pneumonectomy experts recommend VATS only for people with early-stage tumors that are near the outside of the lung. This complex procedure requires a surgeon with a great deal of technical skill and experience.

Why might I need a pneumonectomy?

Lung cancer is the most common reason for a pneumonectomy. Healthcare providers usually try to remove as little as possible of the lung tissue. You might need a pneumonectomy if a smaller surgery would not be able to remove all the cancer. Some cancers located near the center of the lung also need a pneumonectomy instead of a smaller surgery.

Sometimes a pneumonectomy is also needed for other lung diseases. Some of these include:

  • Traumatic lung injury
  • Pulmonary tuberculosis
  • Fungal infections of the lung
  • Bronchiectasis
  • Congenital lung disease
  • Bronchial blockage with a destroyed lung
  • Pulmonary metastases (cancer that has spread to the lungs from another site in the body)

What are the risks of pneumonectomy?

Many people who have a pneumonectomy do very well. But it is a fairly high-risk surgery. Some possible complications are:

  • Respiratory failure
  • Blood clot in the lung (pulmonary embolism)
  • Pneumonia
  • Shock
  • Complications from anesthesia
  • Too much bleeding
  • Abnormal heart rhythms
  • Reduced blood flow to the heart

Your recovery will probably take weeks or even months. If the surgeon spread your ribs to get to the lung, the area near the incision will hurt for some time after surgery. Your overall activity may be limited for 1 to 2 months. If you have emphysema or chronic bronchitis (common diseases among smokers), you might become more short of breath with certain activities.

Your age, any other health problems, and other factors will help determine your risk for complications. Before your surgery, ask your healthcare provider about your specific risks.

How do I get ready for a pneumonectomy?

Ask your healthcare provider about what you need to do to get ready for your pneumonectomy. In general:

  • Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners.
  • If you smoke, you need to quit before your surgery. Ask your healthcare provider for resources to help you.
  • Tell your provider if you have any allergies, including latex.
  • Tell your provider if you’ve ever had a reaction to local or general anesthesia.
  • Daily exercise is an important part of getting ready for surgery. Ask your healthcare provider what kind is best for you.
  • You might need to do breathing exercises with a device called a spirometer.
  • Don’t eat or drink after midnight the night before your surgery.
  • Any hair on or around the surgery site may be removed with clippers before the procedure.

You might also need one or more of the following tests:

  • Chest X-ray, to see the heart and lungs
  • Chest CT scan, to get more detailed pictures of the lungs
  • Positron emission tomography (PET) scan, to look for cancer tissue
  • Electrocardiogram (ECG), to look at your heart rhythm
  • Pulmonary function tests, to see how well your lungs are working
  • Ventilation-perfusion scan, to figure out which areas of the lung contribute most to breathing
  • Blood tests, to check your overall health

What happens during a pneumonectomy?

Ask your healthcare provider about what to expect during your pneumonectomy. The following is a general description of the most common approach. This procedure may differ if your healthcare provider is using minimally invasive surgery. In general:

  • You will lie on your side on an operating table with your arm above your head.
  • You will probably get antibiotics to help prevent infection.
  • You will get anesthesia before the surgery starts. It will put you into a deep sleep so you don’t feel any pain during the procedure.
  • The surgery will take several hours.
  • The surgeon makes a cut several inches long between 2 ribs. The cut will go from under your arm to around your back, on the side of the lung that is being removed.
  • The surgeon separates 2 ribs. In some cases, the surgeon might remove a small part of the rib.
  • The surgeon deflates the affected lung and removes it.
  • The surgeon may remove some nearby lymph nodes. These may help show how advanced a cancer might be.
  • Your surgeon will close the ribs, the muscles, and skin. A dressing will be applied over the incision.
  • Most of the time, a chest tube is left in the pleural space from where the lung was removed. This is removed when your condition improves.

What happens after a pneumonectomy?

Ask your healthcare provider about what to expect. In general:

  • When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
  • Your vital signs will be carefully watched. These include your heart rate, breathing, blood pressure, and oxygen levels. You will have several types of monitors attached to help with monitoring your condition.
  • You may get oxygen through small tubes placed in your nose. This is usually short-term (temporary).
  • You will feel some soreness. But you shouldn’t feel severe pain. If you need it, pain medicine is available.
  • You may do breathing therapy to help remove fluids that collect in your lungs during surgery. You will probably need to do this several times a day.
  • You may wear special stockings (compression stockings) on your legs to help prevent blood clots.
  • You will need to stay in the hospital for several days.

After you leave the hospital:

  • Make sure you have someone to drive you home. You will also need some help at home for a while.
  • You will have your stitches or staples removed in a follow-up appointment. Be sure to keep all of your follow-up appointments.
  • You may tire easily after the surgery. But you will slowly start to recover your strength. It may be several weeks to a month before you fully recover.
  • You need to be up and walking several times a day.
  • Ask your healthcare provider when it will be safe for you to drive.
  • Avoid lifting anything heavy for several weeks.
  • Follow all the instructions your healthcare provider gives you for medicine, exercise, diet, and wound care.
  • Call your healthcare provider right away if you have any signs of infection, fever, swelling, or pain that is getting worse. A small amount of drainage from your incision is normal.
  • Call your provider if you have any questions. Always ask if you have any questions about how to take your medicine or you are worried about any symptoms.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Can you live with one lung? Survival and outlook

It is possible to have only one lung and still function relatively normally.

Although the lungs are vital organs in the body, some conditions can cause a person to lose function in their lungs or need to have one removed.

That said, each person will be different, and there are special considerations in each case, depending on the person’s lung function and any other issues they experience.

Keep reading to learn more.

Share on PinterestA person with one lung can live a relatively normal life.

The lungs are key organs in the human body, responsible for bringing oxygen into the body and helping get rid of waste gases with every exhale.

Though having both lungs is ideal, it is possible to live and function without one lung. Having one lung will still allow a person to live a relatively normal life.

Having one lung might limit a person’s physical abilities, however, such as their ability to exercise. That said, many athletes who lose the use of one lung may still train and be able to continue their sport.

The body adapts to this change in several ways. For instance, the remaining lung will expand a bit to occupy the space left by the missing lung. Over time, the body will also learn to make up for the loss of oxygen.

However, a person will not have full lung capacity, as they did with two lungs, and they will likely need to learn to slow down and adapt to this change.

Although most people expect to be continuously winded or have an inability to function without one lung, this is not usually what happens. The person may have to learn to slow their normal functions down to a degree, but they should be able to lead a relatively normal life with one lung.

Although it is possible to live without a lung, there are a few risks involved.

A study in the Journal of Cancer notes that pneumonectomy, or the surgery to remove one of the lungs, is a high risk surgery that can lead to complications and even death.

Possible complications associated with pneumonectomy include:

  • respiratory failure
  • excessive bleeding and shock
  • abnormal heart rhythms, or arrhythmia
  • reduced blood flow
  • blood clots in the lung, or pulmonary embolism
  • pneumonia

The anesthetic from the surgery also carries its own risks.

The actual pneumectomy process involves making an incision in the side of the body to remove the affected lung.

The space left after removing the lung will fill with air. During recovery, a person may feel temporary abdominal pain or pressure as this air shifts and assimilates into the body. Over time, the other lung will expand a bit to take up some of this space. The space left will naturally fill with fluid.

After a successful surgery, a person will still take a while to recover. Full recovery without complications may take weeks or even months.

While recovering and even after, the person will need to be aware of their limitations and may have to reduce their activity levels significantly.

Some things may cause a person to feel more winded and could put them at risk of reduced blood flow or fainting. Even everyday activities — such as getting out of bed in the morning, standing up from a prone position, or walking up stairs — may cause the person to feel very winded.

Additional factors will also play into a person’s risk. For instance, their general health before the surgery, their age, and any other health conditions they have may affect their individual risks.

People with a history of smoking or other lung conditions that limit their lung function will need to be extra careful. They may need additional assistance during recovery and should work closely with a doctor to understand their risks.

A number of issues may lead to needing a pneumectomy, including:

  • traumatic injury in the area, such as from a serious vehicle accident
  • tuberculosis
  • fungal infections
  • congenital lung disease
  • complications due to smoking
  • cancer
  • bronchiectasis, which also puts a person at risk of frequent infections

Although infections were a major cause of lung removal in the past, this is now much less common. That said, for severe infections that cause widespread damage or are very difficult to treat, lung removal may still be the best course of action.

For an otherwise healthy person, having a lung removed should not cause them to be severely limited. Each person will have to learn their own limitations in each situation, as no two cases will be exactly the same.

A person with other issues that affect the lungs or make it more difficult to breathe may find living with one lung more challenging.

Complications from lung disease or a history of smoking may make it more likely that the person experiences symptoms such as being easily winded or having difficulty catching their breath.

Even still, individual outlook can vary greatly. Although people should not expect to return to their full lung function after a lung removal, in most cases, they may still be able to operate relatively normally.

A lung removal procedure is typically only one part of a person’s treatment. Their adherence to their other treatment regimens will also affect their overall outlook.

Therapies such as pulmonary rehabilitation are important factors in a person’s recovery and overall lung function. A doctor will also give the person breathing exercises to do at home.

Always work with a doctor during the recovery process to discuss possible therapies, as these therapies can be important steps to recovery.

It is possible to live with one lung. However, a person’s ability to exercise will likely decrease.

Lung removal surgery is a serious procedure that involves removing a part of or the entire lung.

People with underlying conditions affecting their lungs may need to pay more attention to their individual risks.

The surgery itself carries some risk, as does the recovery process. A person’s individual outlook will vary greatly based on a number of factors, but having one lung should not decrease a person’s life expectancy.

Anyone who may need to undergo lung removal will talk to a doctor beforehand to discuss all the possibilities of the surgery and life after the procedure.

Recovery procedures and pulmonary rehabilitation may help strengthen the remaining lung and help people gradually improve their lung function.

Lung Transplant – Indications, Preparation, Recovery

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Lung Transplant is an operation to remove and replace a diseased lung with a healthy lung from a donor. The donor is usually a deceased person, but in rare cases, part of a lung may be taken from a living donor. Lung transplants are performed infrequently, mainly due to a lack of available donors as the demand for transplants far exceeds the available supply of donated lungs. This means that an organ transplant will only be performed if there is a relatively high chance of success. For example, lung transplantation would not be recommended for cancer patients because the cancer could return to the donor lungs. If the patient smokes, they will also not be considered for a lung transplant.

When a lung transplant is needed

Lung transplant is often recommended if:

  • the person has advanced lung disease that is not treatable by other methods
  • it is assumed that the life expectancy of a person without transplantation is less than 2-3 years.

Diseases that can be treated with lung transplantation include:

  • chronic obstructive pulmonary disease (COPD) is a general term for a range of conditions that damage the lungs, usually as a result of smoking
  • cystic fibrosis – a hereditary disease in which the lungs and digestive system become clogged with thick, sticky mucus
  • pulmonary hypertension – high blood pressure in the pulmonary arteries idiopathic pulmonary fibrosis – scarring of the lungs.

Why lung transplantation is not suitable for all patients.

The main reasons why a lung transplant is denied include:

  • other organs such as the liver, heart, or kidneys are not working properly and may not be able to handle the extra workload
  • The lung disease is too advanced and the patient is considered too weak to survive the operation
  • recent history of cancer and there is a possibility that the cancer may have spread to the donor lungs
  • there is an infection that would make the transplant too life-threatening
  • have a drug addiction or serious mental illness
  • severely underweight with a body mass index (BMI) less than 16 or very overweight (obese) with a BMI of 30 or more

Age also plays a role as it affects the patient’s likely survival after surgery:

  • patients over 50 years of age will not be considered eligible for heart and lung transplantation
  • Patients over 65 years of age will not be considered eligible for a single or dual lung transplant
  • people over 65 and otherwise healthy may be considered eligible for a single lung transplant.

Types of lung transplant surgery

There are 3 main types of lung transplant:

  • single lung transplant, where one damaged lung is removed from the recipient and replaced with a donor lung. This surgery is often used to treat pulmonary fibrosis, but it is not suitable for people with cystic fibrosis because the infection will spread from the remaining lung to the donor organ. a double lung transplant, in which both lungs are removed and replaced with two donor lungs. This is usually the main treatment option for people with cystic fibrosis or COPD.
  • complex heart and lung transplant, where the heart and both lungs are removed and replaced with donor organs. This surgery is often recommended for people with severe pulmonary hypertension.
  • Living donor lung transplant. In rare cases, a person may receive a lung transplant from a living donor. For 1 recipient, 2 living donors are usually required. During a transplant of this type of lung, the lower lobe of the right lung is removed from one donor and the lower lobe of the left lung is removed from the other donor. Both lungs are removed from the recipient and replaced with donor lung implants in one operation. Most patients who receive lung transplantation from living donors have cystic fibrosis, and the donors are close relatives of the patient because the recipient and donors must be compatible in size and have matching blood types.

Preparing for a lung transplant

Before being placed on the waiting list for surgery, a patient must undergo several examinations to ensure that major organs such as the heart, kidneys, and liver will function normally after transplantation. To do this, the patient is given:

  • a series of blood tests
  • Cardiac ultrasound
  • electrocardiogram
  • CT lungs
  • CT angiography of pulmonary vessels or MR angiography of pulmonary vessels
  • CT abdomen
  • Ultrasound of the kidneys.

In addition, the patient will need to undergo:

  • consultation with a transplant surgeon
  • Anesthesiologist consultation
  • intensive care specialist consultation
  • pulmonologist consultation
  • infectious disease consultation
  • consultation with a physiotherapist.

After the assessment is completed, a decision will be made on whether a lung transplant is suitable for the patient and whether it is the best treatment option.

How a lung transplant works

When a suitable donor is found, the patient usually needs to be in the hospital ready for the transplant within 6-8 hours. A lung transplant operation usually takes 4 to 12 hours, depending on the complexity of the operation. During the procedure, a breathing tube will be inserted into the throat so that the lungs can be ventilated. The surgeon will then make an incision in the chest and prepare to remove the affected lung or lungs. If circulatory assistance is needed, a heart-lung machine can be used to keep the blood circulating during surgery. The donor lung will then be connected to the appropriate airways and blood vessels. When the transplant team is confident that the new lung is working effectively, the chest will be closed, but the tubes will be left in the chest for a few days to drain any accumulated blood and fluid. A lung transplant is a major operation that can take at least 3-6 months to recover from.

There are 2 new surgical methods that can increase the number of donor lungs:

  • Transplant after donation without heart rhythm . Most donor lungs come from people who have died but whose heart continues to beat using life support equipment. Often these are people who died after a long illness. Modern medical technology now allows you to take the lungs from a suddenly deceased person and keep the organs “alive” for about an hour, passing oxygen into them. Oxygen supports the biological processes in the lungs, keeping tissues from dying off.
  • Lung perfusion. Lungs can be damaged when the brain dies before they are taken for donation. Due to this situation, only 1 in 5 lungs is suitable for donation. Ex vivo lung perfusion is a novel technique developed to address this problem. It allows the lungs to be removed from the body and quickly placed in a perfusion unit. The blood, protein, and nutrients are then pumped into the lungs, which repairs the damage.

Recovery after surgery

After surgery, the patient may be given an epidural to relieve pain and put on a ventilator to help breathe easier. During the first 7 days, the patient will be closely monitored so that the transplant team can check whether the body accepts the new organ. Monitoring will include regular chest CT scans and lung biopsies. Most likely, the patient will be discharged from the hospital 2-3 weeks after the operation and scheduled for daily check-ups for a month. Usually, follow-up after lung transplant surgery requires at least 3-6 months. After completing the recovery course, the patient will have to donate blood for analysis every 6 weeks and visit a pulmonologist every 3 months for the rest of his life.

Immunosuppressive therapy after lung transplant

The patient will need to take immunosuppressive drugs to prevent the body from rejecting the donor organ. The therapy is usually divided into 3 stages:

  • induction therapy, where the patient is given a combination of high doses of immunosuppressants immediately after transplantation to weaken the immune system
  • antibiotics and antivirals to prevent infection
  • maintenance therapy where the patient is given a combination of immunosuppressive drugs at a lower dose to “keep up” a weakened immune system.

This maintenance therapy is carried out for the rest of the patient’s life.

Most transplant centers use the following combination of immunosuppressants:

  • tacrolimus
  • mycophenolate
  • mofetil
  • corticosteroids.

The downside of taking immunosuppressants is that they can cause a wide range of side effects, including:

  • mood changes such as depression or anxiety
  • insomnia
  • diarrhea
  • swollen gums
  • convulsions
  • dizziness
  • headache
  • acne
  • additional hair growth (hirsutism)
  • weight gain.

Long-term use of immunosuppressants increases the risk of developing other diseases such as kidney disease.

Your doctor will try to find a dose of immunosuppressant that is high enough to weaken the immune system but low enough to minimize side effects. It will take several months to determine the correct dosage, but even if the side effects are worrying, the patient should never stop taking the medicine without the permission of the doctor.

The condition of a weakened immune system is called immunodeficiency and the patient needs to take additional measures against the infection:

  • practice good personal hygiene – take a bath or shower daily and make sure that clothes, towels and bedding are washed regularly.
  • avoid contact with people with infections wash hands regularly with soap and hot water, especially after going to the toilet and before preparing and eating food
  • avoid cutting or scratching the skin
  • get regular vaccinations.

The patient should also look for any signs that may indicate that they have an infection:

  • fever
  • headache
  • aching muscles.

Remember, a minor infection can lead to very serious complications and quickly turn into a life-threatening condition for the patient.

Risks of lung transplantation

Lung transplantation is a complex operation with a high risk of complications. The most common is the rejection of donor lungs. For this reason, immediately after surgery, the patient is prescribed immunosuppressants to weaken the influence of the immune system and reduce the risk of rejection. Taking immunosuppressants comes with some risks because they increase the chance of infections and blood poisoning. Although complications can occur at any time, serious complications are more likely to occur in the first year after transplantation.

Reimplantation reaction is a common complication that affects almost all lung transplant patients when the lungs fill with fluid as a result of surgery and circulatory failure. Symptoms of this condition include:

  • coughing up blood
  • Confused and labored breathing when lying down.

This condition usually develops 5 days after transplantation, but in many people the symptoms disappear 10 days after transplantation.

Rejection is a normal reaction of the body to foreign tissues. When a donor organ is transplanted, the immune system sees it as a threat and develops antibodies against it, which can interfere with the normal functioning of the respiratory system. Most people experience rejection usually within the first 3 months after transplantation. Shortness of breath, extreme fatigue, and a dry cough may indicate a risk of rejection. Acute rejection usually responds well to steroid treatment.

Bronchiolitis Obliterans Syndrome is another form of rejection that usually occurs in the first year after transplantation, but can occur up to a decade later. In this condition, the immune system causes inflammation of the airways inside the lungs, which blocks the flow of oxygen through the lungs. Symptoms of the disease include:

  • troubled breathing
  • dry cough
  • wheezing.

Bronchiolitis obliterans syndrome can be treated with additional immunosuppressants.

Lung transplantation increases the risk of developing lymphoma (usually non-Hodgkin’s lymphoma), a type of cancer that affects white blood cells. This condition is known as post-transplant lymphoproliferative disease. It occurs when a viral infection (usually Epstein-Barr virus) develops as a result of the action of immunosuppressive drugs, which are used to prevent the body from rejecting a new organ.

Post-transplant lymphoproliferative disease affects about 1 in 20 lung transplant patients. Most cases of this complication occur within the first year after transplantation and are treated with reduction or withdrawal of immunosuppressant therapy.

The risk of infection for lung transplant patients is higher than average for a number of reasons, including: Immunosuppressants weaken the immune system, which means that an infection is more likely to take hold and a minor infection is more likely to turn into a serious infection. People often have an impaired cough reflex after a transplant, which means they cannot clear mucus from their lungs, which creates an ideal environment for infection. surgery can damage the lymphatic system, which normally protects against infection. people may be resistant to one or more antibiotics as a result. of their condition, especially those with cystic fibrosis.

Common infections after transplantation include:

  • bacterial or viral pneumonia
  • cytomegalovirus (CMV)
  • aspergillosis, a type of fungal infection caused by spores.

After any type of transplant, immunosuppressants should be taken, although they increase the risk of developing other diseases. Kidney disease is a common long-term complication of immunotherapy. It is estimated that 1 in 4 patients will develop some degree of kidney disease a year after a lung transplant. About 1 in 14 people will have kidney failure within a year of a transplant, rising to 1 in 10 after 5 years.

Diabetes , especially type 2 diabetes, develops in about 1 in 4 patients one year after a lung transplant.

High blood pressure develops in about half of all patients one year after lung transplantation and in 8 out of 10 people after 5 years. High blood pressure can develop as a side effect of immunosuppressants or as a complication of kidney disease. Like diabetes, high blood pressure is treated with lifestyle changes and medications.

Osteoporosis usually occurs as a side effect of immunosuppressive drugs. Treatment options for osteoporosis include vitamin D supplements and drugs known as bisphosphonates, which help maintain bone density.

Patients who have had a lung transplant have an increased risk of developing cancer at a later date, especially:

  • skin cancer
  • lung cancer
  • liver cancer
  • kidney cancer
  • non-Hodgkin’s lymphoma, cancer of the lymphatic system.

Because of this increased risk, regular screening for these cancers may be recommended.

The outlook for life after a lung transplant

The outlook for people who have a lung transplant has improved in recent years and about 9 out of 10 people are expected to survive surgery, with the majority surviving at least a year after surgery. About 5 out of 10 people will live at least 5 years after a lung transplant.

Author: Sergeev Alexander Nikolaevich

Specialization: Hematologist, Toxicologist, Occupational Pathologist, Anesthesiologist-Resuscitator

Place of appointment: Research Institute of Hematology and Transfusiology 903 00

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Literature

  1. Vasyukevich A. G. Anatomical substantiation of lung sampling and transplantation: dis. . cand. honey. Sciences: 14.00.27. – M., 1991. – 165 p.
  2. Kitaev V.V. HRCT in the diagnosis of lung diseases.// Med. Visualization. 1997. – No. 4. – S. 21-26.
  3. Perelman M.I. Lung transplantation // Clinical medicine. – 1991. -№7. – S. 3-9.
  4. Ragimov F. R., Kokshenev I. V. Lung transplantation // Grud. and cardiovascular surgery. – 1996. – No. 2. – S. 69-72.
  5. Yablonsky PK Transplantation of an isolated lung : (Experimental and clinical research) : dis. . Dr. med. Sciences: 14.00.27. – St. Petersburg, 1999. – 365 p.
  6. Meyer KC. Recent advances in lung transplantation. F1000Res. 2018 Oct 23;7:F1000 Faculty Rev-1684. doi:10.12688/f1000research.15393.1. PMID: 30416706; PMCID: PMC6206601.
  7. Afonso Júnior JE, Werebe Ede C, Carraro RM, Teixeira RH, Fernandes LM, Abdalla LG, Samano MN, Pêgo-Fernandes PM. lung transplantation. Einstein (Sao Paulo). 2015 Apr-Jun;13(2):297-304. doi: 10.1590/S1679-45082015RW3156. PMID: 26154550; PMCID: PMC4943827.
  8. Hachem RR. Acute Rejection and Antibody-Mediated Rejection in Lung Transplantation. Clinic Chest Med. 2017 Dec;38(4):667-675. doi: 10.1016/j.ccm.2017.07.008. Epub 2017 Sep 1.PMID: 29128017.

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Easy to check lungs | Articles of the clinic Medservice

May 22, 2018

Author of the article: Ekaterina Yurievna Zolotareva, doctor of functional diagnostics

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No breath means no life. To be healthy and energetic, you need to have even and easy breathing. What is your breath like? Maybe you don’t know something about yourself? This test should help determine if you have problems with your respiratory system. Find out about the quality of your breathing by answering the following questions.

1. Do you breathe through your nose or sometimes through your mouth when you are at rest?
Inhalation should always be done through the nose, except in cases of pronouncing long phrases (verbal breathing), exhalation is also possible through the mouth.

2. How many inhalations and exhalations do you take per minute while at rest?
If your health is in order, in a calm state there should be from 8 to 12 respiratory cycles per minute.

3. Do you have breaks between inhalation and exhalation, between exhalation and the next inhalation?
In a calm state, your breathing should be continuous, that is, there should be no breaks between inhalation and exhalation.

4. Lean your back against a wall or back of a chair – in which part of your back do you feel movement as you inhale and exhale ?
It is normal if during inhalation you can feel the pressure of the back on the support in any of its areas. Most of the time it is best to breathe in the lower part of the lungs, pushing the stomach and lower back forward. This is the easiest breath.

5. Can you continuously pronounce the sound “ah” for 20 seconds?
If the longest exhalation is noticeably shorter, your breathing is too shallow, then all your internal organs experience oxygen starvation.

6. Do you ever get told that you snore? Or maybe your voice gets low in the morning?
Being healthy means having no such symptoms.

Respiratory disorders are most often associated with illness or poor physical fitness. To be healthy, to maintain ease of breathing, go through spirography, find out everything about the functional state of the respiratory system.

If you are interested in the health of the respiratory tract, often cough or runny nose, you smoke, often work outdoors, go in for sports, come to the Medservice clinic and undergo an examination of the function of external respiration (spirography). The procedure is painless, safe and informative.

Breathe easily and freely and be healthy!

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Author of article

Zolotareva Ekaterina Yurievna

functional diagnostics doctor

A unique clinical experience was formed during the years of work in the women’s cardiology department of the Izhevsk Cardiology Center under the guidance of Associate Professor of the Department of Hospital Therapy Valeeva R. M. Ekaterina Viktorovna is often consulted by obstetricians and gynecologists who work with pregnant women with complex pathologies of the cardiovascular system.

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