American Medical Association Family Medical Guide - American Medical Association [406]
Complications that can occur after lung transplant surgery include severe bleeding or blood clots, pneumonia that can be life-threatening, and pulmonary edema (fluid buildup in the donated lung). Survival rates for organ transplantation in general and lung transplants in particular continue to improve. About 75 percent of all lung transplant recipients are alive 1 year after surgery, and 45 percent are alive after 5 years.
Heart-Lung Transplants
A heart-lung transplant is the transfer of a heart and two lungs (in rare cases, one lung) from an organ donor to a recipient. Doctors recommend a heart-lung transplant when a person has advanced lung disease that has also affected the heart and when all other medical and surgical options have been unsuccessful. The leading condition for which heart-lung transplants are performed is severe pulmonary hypertension (elevated blood pressure in the vessels of the lungs that limits blood flow; see page 594) caused by a birth defect of the heart such as cystic fibrosis (see page 958). People under age 45 are the best candidates for the procedure, although it can be performed up to age 60.
Organ availability is an obstacle to successful heart-lung transplantation. There is a scarcity of potential donors who have normally functioning lungs because lung infections and changes in lung function begin to occur very soon after death. Like all people with transplants, heart-lung recipients must take antirejection drugs for life. The outlook for heart-lung transplant recipients depends on the person’s age and general health but, overall, about 70 percent of people who receive combined heart-lung transplants in the United States survive for 1 year.
Heart-lung transplant
The donor’s heart and lungs may be transplanted directly from the donor at the time of surgery or removed from the donor a few hours before transplantation and kept cool in a special solution. The heart and lungs are removed by severing the trachea, aorta, and the point at which the heart connects to the venae cavae (the two major veins that drain oxygenated blood from the body into the right side of the heart). Blood vessels linking the donor heart and lungs are left intact.
To transplant the donor’s organs (shaded areas) into the recipient, a surgeon makes an incision in the breastbone of the recipient and opens the chest. The recipient is connected to a heart-lung machine, which removes carbon dioxide and replaces it with oxygen, and allows blood flow to bypass the heart and lungs. The recipient’s diseased heart and lungs are removed separately. The new lungs are attached first, then the heart, followed by the blood vessels. The main reconnections are between the recipient’s and the donor’s tracheas and aortas and between the right atrium of the donor’s heart and the recipient’s venae cavae.
Postural drainage
Postural drainage techniques help you drain phlegm from your lungs. In one position, you lie facedown on a bed with your head and chest hanging over the edge of the bed for 5 to 10 minutes twice a day to help your lungs drain. Have someone gently clap your back and the sides of your chest at the same time to help loosen phlegm (learn how to do this properly from a respiratory therapist).
Diagnosis
If you are coughing up large amounts of phlegm, your doctor will listen to your lungs with a stethoscope and will probably recommend diagnostic tests such as a chest X-ray and lung function tests (see page 647) to confirm the diagnosis.
Treatment
If you have bronchiectasis, your doctor will probably recommend that you learn some body postures called postural drainage (see next page) to help airway secretions drain from your lungs. If you smoke, stop (see page 29). Avoid breathing in smoky or polluted air. Try to avoid getting colds and other respiratory infections. Your doctor will prescribe an antibiotic at the first sign of an infection. In severe, frequently recurring cases of bronchiectasis, a doctor may recommend