Our Summary

The research paper investigates the effectiveness of lobar lung transplantation - a procedure that involves transplanting a part of a lung instead of a whole lung - from deceased donors. The researchers believe this could be a potential solution for those patients who are smaller and may not be a good fit for a standard-sized lung transplant.

The team looked at patient data from their institution from 2000 to 2017. They found that although lobar lung transplants were more frequently used for patients in rapidly deteriorating conditions and required longer stays in intensive care units and hospitals, the long-term survival rates were similar to those of standard lung transplants. Despite higher mortality rates in the first 30 days after surgery, the 1, 3, and 5 year survival rates were not significantly different.

In conclusion, the researchers suggest that lobar lung transplantation is a high-risk procedure, but its mid and long-term outcomes are similar to those of standard lung transplants. Therefore, it could be a valuable option for smaller patients.

FAQs

  1. What is lobar lung transplantation and who can it benefit?
  2. How do the survival rates of lobar lung transplantation compare to standard lung transplants?
  3. Why is lobar lung transplantation considered a high-risk procedure?

Doctor’s Tip

A doctor might tell a patient considering a lung transplant that lobar lung transplantation is a potential option for those who are smaller and may not be a good fit for a standard-sized lung transplant. While it is a high-risk procedure, the long-term survival rates are similar to standard lung transplants. It is important for the patient to weigh the risks and benefits with their healthcare team to determine the best course of action for their individual situation.

Suitable For

Patients who are typically recommended for lung transplant are those with end-stage lung disease who have exhausted all other treatment options and have a life expectancy of less than 2-3 years. Some common conditions that may warrant a lung transplant include:

  • Chronic obstructive pulmonary disease (COPD)
  • Cystic fibrosis
  • Idiopathic pulmonary fibrosis
  • Pulmonary hypertension
  • Alpha-1 antitrypsin deficiency
  • Bronchiectasis
  • Sarcoidosis

Patients who are younger, have fewer co-morbidities, and are in overall better health are more likely to be considered suitable candidates for lung transplantation. Additionally, patients must be willing and able to comply with post-transplant care and medications, as well as undergo extensive evaluation and testing to determine their eligibility for a transplant.

Timeline

Before lung transplant:

  1. Patient is diagnosed with end-stage lung disease and is evaluated by a transplant team.
  2. Patient undergoes extensive medical and psychological evaluations to determine eligibility for transplant.
  3. Patient is placed on the national transplant waiting list and waits for a suitable donor.
  4. Patient may experience worsening symptoms and decreased quality of life while waiting for a transplant.
  5. Patient receives a call that a donor lung is available and goes through pre-transplant preparations.

After lung transplant:

  1. Patient undergoes lung transplant surgery, which can take several hours.
  2. Patient is closely monitored in the intensive care unit (ICU) immediately post-surgery.
  3. Patient may experience complications such as organ rejection or infection in the weeks and months following surgery.
  4. Patient undergoes extensive rehabilitation and physical therapy to regain strength and lung function.
  5. Patient is closely monitored for signs of rejection or complications for the rest of their life.
  6. Patient experiences improved lung function and quality of life post-transplant, but must adhere to a strict medication regimen and follow-up care plan.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with lobar lung transplantation compared to standard lung transplantation?
  2. How does the recovery process differ for patients undergoing lobar lung transplantation?
  3. What criteria are used to determine if a patient is a suitable candidate for lobar lung transplantation?
  4. How does the availability of donor lungs differ for lobar lung transplantation compared to standard lung transplantation?
  5. What are the long-term follow-up care and monitoring requirements for patients who have undergone lobar lung transplantation?
  6. Are there any specific lifestyle changes or medications that need to be followed post-lobar lung transplantation?
  7. How does the success rate of lobar lung transplantation compare to standard lung transplantation in terms of lung function and quality of life?
  8. Are there any ongoing research studies or advancements in lobar lung transplantation that I should be aware of?
  9. What support services are available for patients undergoing lobar lung transplantation, both before and after the procedure?
  10. How does the cost of lobar lung transplantation compare to standard lung transplantation, and what financial assistance options are available?

Reference

Authors: Campo-Canaveral De La Cruz JL, Dunne B, Lemaitre P, Rackauskas M, Pozniak J, Watanabe Y, Mariscal A, Yeung J, Yasufuku K, Pierre A, de Perrot M, Waddell TK, Cypel M, Keshavjee S, Donahoe L. Journal: J Thorac Cardiovasc Surg. 2021 May;161(5):1674-1685. doi: 10.1016/j.jtcvs.2020.04.166. Epub 2020 May 23. PMID: 32723591