Our Summary

This research paper is about a 27-year-old man who had a severe lung disease when he was a kid, which required a lung transplant. After the operation, he had complications like his new lungs not functioning properly and his kidneys failing. He needed continuous kidney dialysis and was on a ventilator because of too much mucus in his lungs. Eventually, he was able to breathe with the help of a high-flow nasal cannula, a device that helps deliver oxygen.

However, the night before his mental condition took a turn, he had a day-night reversal, meaning he was awake when he should have been sleeping and vice versa. The next day, he became aggressive, violent, and confused, which later turned into sleepiness and lethargy. This led to him needing a tube placed in his windpipe to help him breathe and protect his airway. He also had low blood pressure, which required medication to help increase it.

FAQs

  1. What complications did the patient experience following his lung transplant?
  2. What caused the patient’s change in mental status after lung transplantation?
  3. What treatments were required for the patient’s acute renal failure and primary graft dysfunction post-lung transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung transplant is to closely follow the postoperative care plan provided by the medical team. This may include taking prescribed medications as directed, attending follow-up appointments, and participating in pulmonary rehabilitation to optimize lung function and overall health. It is important to communicate any changes in symptoms or concerns to the medical team promptly to ensure the best possible outcome after a lung transplant.

Suitable For

Patients who are typically recommended for lung transplant are those with end-stage lung disease that is unresponsive to other treatments, such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis, pulmonary hypertension, and other respiratory diseases. These patients may have severe symptoms such as shortness of breath, chronic cough, fatigue, and decreased exercise tolerance despite optimal medical management. Additionally, they may have a poor prognosis and limited life expectancy without a lung transplant. It is important for patients to meet specific criteria, including being in good overall health aside from their lung disease, having a strong support system, and being compliant with post-transplant medications and follow-up care.

Timeline

  • Before lung transplant:

  • Patient with history of bronchiolitis obliterans caused by severe viral illness during childhood

  • Required lung transplantation

  • Started on tacrolimus therapy

  • Developed severe primary graft dysfunction and acute renal failure requiring CRRT

  • Prolonged intubation with periodic BAL for mucous plugging

  • Weaned to high-flow nasal cannula and then 2 L/min by nasal cannula post-transplant

  • After lung transplant:

  • Experienced day/night inversion

  • Became combative, violent, and confused

  • Altered mentation progressed to somnolence and lethargy

  • Endotracheal intubation for airway protection

  • Hypotension requiring low-dose epinephrine and vasopressin infusions

What to Ask Your Doctor

  1. What are the potential risks and benefits of a lung transplant for my specific condition?
  2. How long is the recovery process expected to be after a lung transplant?
  3. What medications will I need to take after the transplant and what are the potential side effects?
  4. How often will I need to follow up with my transplant team after the surgery?
  5. What signs or symptoms should I watch for that may indicate rejection of the transplanted lung?
  6. How will a lung transplant affect my ability to exercise and perform daily activities?
  7. Are there any dietary or lifestyle changes I should make after a lung transplant?
  8. What support services are available for lung transplant recipients, such as counseling or support groups?
  9. What is the success rate of lung transplants for patients with my specific condition?
  10. What is the likelihood of needing a second lung transplant in the future?

Reference

Authors: Loeb D, Spear C, Hayes D Jr. Journal: Chest. 2022 Mar;161(3):e149-e152. doi: 10.1016/j.chest.2021.09.027. PMID: 35256088