American Medical Association Family Medical Guide - American Medical Association [405]
In rare, severe cases of emphysema, a lung transplant (see below) may be the only option. The heart is frequently transplanted along with the lung (also below).
Bronchiectasis
Bronchiectasis is a disorder that causes permanent damage to and enlargement of one or more bronchi (the main air passages of the lungs). The condition takes years to develop and is usually the result of frequent infections during childhood. The damage to the airways prevents fluid in the airway from draining. Bacteria can multiply in the stagnant fluid and cause infections. If you have bronchiectasis, you are more susceptible to developing lung infections.
Symptoms
The main symptom of bronchiectasis is a frequent cough that brings up large quantities of unpleasant-smelling phlegm that may contain small amounts of blood. The coughing and the amount of phlegm usually increase when you change position, such as when you lie down.
Lung Transplants and Heart-Lung Transplants
Lung Transplants
Doctors recommend a lung transplant when a person has irreversible lung failure that cannot be corrected with other medical or surgical treatments. Surgeons may transplant two lungs, a single lung, or part of a lung. The most common causes of lung failure requiring a transplant are:
• Emphysema (damage to the tiny air sacs in the lungs)
• Pulmonary fibrosis (scarring of lung tissue)
• Cystic fibrosis (an inherited disease that affects the lungs and digestive system)
• Deficiency of a liver protein (alpha1-antitrypsin deficiency) that leads to emphysema (see page 656)
• Pulmonary hypertension (elevated blood pressure in the vessels of the lungs that damages the heart)
Lung transplants can be performed on people ranging in age from infancy to 60 years, but the person must be in otherwise good health. Conditions that can prevent someone from getting a lung transplant include cancer, an untreatable infection, or serious heart, liver, or kidney problems that could make a transplant risky. A team of specialists in lung transplantation evaluates each person seeking a transplant and places suitable candidates on a waiting list. Because the demand for donor lungs far exceeds the supply, a person could wait several years for a suitable donor organ. When an organ becomes available, it goes to the person who has been on the waiting list longest and whose blood type and body size most closely match those of the donor.
Surgeons must transfer a donor lung to the recipient within 4 to 6 hours of the donor’s death. During surgery, the recipient is placed on an artificial breathing machine called a ventilator, which takes over his or her breathing. The surgeons remove the diseased lung along with the blood vessels that attach the lung to the heart and a bronchus (large airway) and replace them with those from the donor. If both lungs are being replaced, the second diseased lung will then be removed and replaced with the donor lung. After transplant surgery, the recipient may stay on the ventilator for up to 12 hours while recovering in the intensive care unit. After 7 to 10 days, he or she can go home.
As with any organ transplant, the major risk is possible rejection of the transplanted organ by the body. The immune system treats the new lung as an invading organism and tries to destroy it. To reduce the risk of rejection of the donated lung, the person must take drugs to suppress his or her immune system. However, in addition to reducing the risk of organ rejection, drugs that suppress the immune system increase the person’s risk of severe infections such as pneumonia. For this reason, the person will also need to take antibiotics and other infection-fighting