Transplant ( transplant ) light
Pulmonology / / August 12, 2017
lung transplant (transplant) - a surgical procedure on the patient's lung to replace a healthy, usually from a deceased donor.During transplantation can be performed as a lung transplantation or two.In some situations, the lungs can be transplanted with a donor heart.
However, long waiting time of donor organs and contingencies are strong obstacles to this procedure.
indications for lung transplantation
Lung transplantation shows that to improve the quality of li
Lung transplantation is performed at various lung diseases such as pulmonary fibrosis, pulmonary hypertension, cystic fibrosis, congenital heart disease.Chronic obstructive pulmonary disease and emphysema are the most common causes of lung transplantation.
Despite the complexity of the operation and the need for continuous use of immunosuppressive drugs after it, this operation can significantly prolong and improve the quality of life of patients with terminal lung damage.
In 2005, a survey of patients of the National Institute of Heart, Lung, and Blood, which lung transplantation was performed, reports that:
- More than 82% of patients survive the first year after transplant;
- About 60% live 3 years after transplantation;
- More than 43% survive 5 years or more after transplantation.
Who is a candidate for lung transplantation?
best candidates for lung transplant must have serious heart and lung disease, with a life expectancy of less than 18 months, when it is already exhausted all the possibilities of drug therapy.
Candidates for lung transplantation must have the following characteristics:
- Poor lung function (FEV1 less than 40% but more than 20% of predicted);
- diffusion capacity of carbon monoxide by more than 20% of predicted;
- hypervolume lung (total lung capacity by more than 120% of predicted);
- Age less than 65 years (although some overseas programs are designed for older patients);
- Secondary pulmonary hypertension;
- Having a normal weight (not overweight, but not enough).
Contraindications to transplantation (transplant) light
- Infectious diseases, HIV, hepatitis B and C;
- Deformation of the chest;
- Scars membrane around the lungs;
- Severe comorbidities such as renal failure, heart failure, liver failure;
- Nicotine, drug or alcohol addiction;
- Overweight (BMI over 30 kg / m2);
- dependence on corticosteroids;
- Psychological problems;
What if the patient had a previous lung surgery?
Previous surgery on the lung such as lung volume reduction or bullectomy do not have contraindications to lung transplantation.
waiting time and search for a donor lung
number of people in need of lung transplant far exceeds the number of donor lungs, so the expectation of donor lungs can take months or even years.Up to one-third of patients awaiting lung transplant die before a suitable donor.
living donor lung transplants are very rare.Sick baby's lungs can be replaced portion (shares) light, taken from healthy adult - usually a parent.
organ allocation assessment should take into account the patient's ability to survive after transplantation.Search
donor depends on certain criteria, including:
- Blood group;
- body size compared to the thoracic cavity;
- The geographical distance between the donor and the recipient;
- The severity of lung disease patients waiting for transplants;
- The probability that the transplant will be successful.
In connection with these criteria medical information about the recipient should be updated every six months.Patients awaiting transplant, must be ready to act quickly if suddenly there is a suitable donor.Team doctors have to know how to contact you at all times.Bag to the hospital should always be packed as if you are going to go for an operation within a few hours.
stroke transplant surgery (transplantation) light
The procedure is performed under general anesthesia, during which the patient is asleep and not feel anything.During the operation carried out in the same mechanical ventilation.The surgeon makes an incision to remove the diseased lungs, after which the main airways (bronchi) and blood vessels between the lungs and the heart will be connected to the donor lungs.
As a rule, during lung transplantation, patients are connected to a heart-lung machine, which carries blood circulation during surgery.
-lung transplantation takes about 4-8 hours, while two light transplantation usually takes 6 to 12 hours.
after lung transplantation
Immediately after surgery, the patient is transferred a few days in the intensive care unit.Mechanical ventilation helps to breathe for a few days until the transplanted lungs do not expand enough.
Drainage tubes are also placed in the incision area, which would drain the excess fluid of the lungs and heart.Intravenous medications will control the pain, and to prevent rejection of the new lung.
With the improvement of the status, when the patient is no longer in need of mechanical ventilation, he was transferred from intensive care to a hospital, where recovery often takes one to three weeks.
After discharge from the hospital, it takes about three months, frequent monitoring by lung transplant team for the prevention, detection and treatment of complications and evaluation of new lung function.All this time you need to be near the transplant center.Follow-up visits may include laboratory tests, chest x-ray, electrocardiogram (ECG) and inspections by experts.
Healthy lifestyle is the key to maintaining a new light.Smoking, and alcohol consumption is strictly limited.Diet can also help maintain health.Exercise is an extremely important part of rehabilitation after lung transplantation.
forecast transplant (transplant) light
lung transplant can significantly improve quality of life.In the first year after the transplant - when surgical complications, infection and rejection are the greatest threat - this is the most critical period.
Although some people have lived 10 years or more after a lung transplant, only about half of the people who undergo the procedure are still alive after five years.
Patients who had undergone lung transplantation must take drugs that suppress the immune system to prevent rejection of the transplanted organ by the immune system.The rejection of these drugs is a major cause of morbidity and mortality.Mortality from the procedure is about 10%.
lung transplant complications
Complications associated with lung transplant can sometimes be fatal.There are two main risks: rejection and infection.
1. Risk ottozheniya transplanted lung. Our immune system protects the body from foreign substances.Even at the maximum possible correspondence between the recipient and the donor, our immune system will try to attack and reject the new lung or lungs.Therefore, post-operative treatment would include drugs to suppress the immune system to prevent organ rejection.
immunosuppressive drugs can t cause significant side effects, including:
- Weight gain;
- Swelling of the face;
- hair on your face;
- Problems with the stomach;
- Kidney damage;
2. Infection. immunosuppressive drugs inhibit the immune system, making the body more vulnerable to infections, particularly in the lungs.
To prevent infection it is necessary:
- Wash your hands often
- Take care of your teeth and gums
- Protect your skin from scratches and wounds
- Avoid the crowds and sick people
- In time to receive appropriate immunizations
addition to rejection and infectionlung transplant complications include:
- lymphoproliferative disorders;
- bronchiolitis obliterans;
alternative to lung transplantation
alternative lung transplant treatment for severe lung disease may be surgery to reduce lung volume.
During this procedure, more than 30% of the heavy defeat of the lung tissue is removed and the remaining parts of the lung are connected together.Improved breathing after surgery is mainly due to the following factors:
- Improving the capacity of the lungs and the chest wall to shrink;
- Improvement in the diaphragm function associated with breathing.
In successful cases, the improvement is most noticeable during the first 6 months, after which the state begins to deteriorate again.After 3 years, lung function deteriorates to the same level as it was before the procedure, whereas one year after lung transplantation and patients have much better lung function, greater exercise tolerance, less shortness of breath.However, transplantation much more expensive than the decrease in lung volume and is accompanied by a lot of risks and complications.
Currently, the preferred method is surgery on both lungs (bilateral lung volume reduction).Surgeons use either an open approach with a large incision in the chest, or VATS, which is a less invasive procedure and requires a few small incisions.Both methods are effective and have similar complication rates.
How much is a lung transplant?
And lastly, what is the price issue lekih transplant?Here is a brief list of the prices for this procedure:
- The cost of such an operation in the United States ranges from 450 - 750 thousand dollars.
- In Israel, lung transplant is between 130 - 300 thousand $..
- In Europe, lung transplantation is from 75 to 100 thousand euros.
- India lung transplant will cost from $ 60 thousand..