Reasons for Lung Transplant
Diseases leading to lung transplant
Though many diseases affect the lungs, not all lung diseases are treated with a lung transplant. The most common diseases that lead to lung transplantation are cystic fibrosis, pulmonary hypertension, bronchiolitis obliterans and interstitial lung disease. Other diseases that damage the lungs and can lead to transplant include:
- Bronchiolitis obliterans (post-infectious, associated with Stevens Johnson Syndrome, associated with bone marrow transplant and lung transplant)
- Bronchopulmonary dysplasia without major co-morbidities
- Chronic aspiration of gastric contents which will not recur
- Chronic interstitial lung disease
- Cystic fibrosis
- Diffuse pulmonary arteriovenous shunt syndromes
- End-stage bronchiectasis due to a treatable form of immunodeficiency
- Surfactant protein dysfunction syndromes
- Idiopathic pulmonary arterial hypertension
- Pulmonary fibrosis after radiation therapy
- Pulmonary fibrosis after severe pneumonia or adult respiratory distress syndrome
- Pulmonary hemosiderosis
- Pulmonary Hypertension with associated congenital heart disease (if heart defect can be repaired at the time of transplant)
- Pulmonary hypoplasia (under-development), either as an isolated condition or due to congenital diaphragmatic hernia or malformations of the lung or chest wall
- Pulmonary veno-occlusive disease
- Pulmonary vein stenosis, refractory to interventions
Many types of lung disease may lead to end-stage pulmonary failure. In some cases, the lung disease may also severely affect the function of the heart, which may necessitate a heart and lung transplant.
Candidates for lung transplant
Your child may be a candidate for lung transplant if:
- Their severe lung disease cannot be significantly improved by either medical therapy or surgery.
- There is a high probability of death within months to 2 years.
- Their quality of life has decreased to the point when transplantation is a better option.
The other criteria are that your child has a reasonable opportunity to survive until transplant, to survive the surgery and to recover to a near normal life.
Multi-organ transplant candidacy
Some children with congenital heart disease develop pulmonary hypertension and have congenital heart defects that cannot be fixed with surgery. These children are potential candidates for pediatric heart-lung transplantation. Patients with severe liver and lung disease may also be candidates for lung-liver transplantations.
Types of lung transplant
Bilateral or double lung transplant
Most infants, children and adolescents who are candidates will receive 2 lungs from a deceased donor who has been diagnosed with brain death. Bilateral or double lung transplant organs are matched by blood type and the height of the donor and recipient. Children 12 years of age or older are listed with a lung score as well. The standard transplant operation involves several hours of cardiopulmonary bypass (a heart-lung machine), and the operation takes approximately 6 to 10 hours.
In unusual circumstances, heart-lung transplantation or lung-liver transplantation may be necessary. The heart and lungs of a single donor are implanted together while the child is on cardiopulmonary bypass. The same surgeons who perform the isolated lung transplantation also perform this procedure.
In the lung-liver scenario, the lung transplant is done first and then a second surgical team joins the operation and performs the liver transplant with the organs coming from the same donor. In this case, the operation can easily extend to 10 hours or more.