Reasons for Lung Transplantation | Lung Transplant Reasons

All standard medical options are tried and have usually failed before transplant is considered.

Lung transplant may be an option for some patients when the lungs become so damaged by disease that they can no longer get oxygen and carbon dioxide in and out of the blood. This is called end-stage lung disease. Some causes of end-stage lung disease are listed below.

Bronchiectasis and Cystic Fibrosis

Bronchiectasis is a condition where abnormal dilatation of the airways results in frequent infections. The lower parts of the lungs are the most frequently infected. Patients with bronchiectasis may cough up large amounts of sputum every day. Antibiotics are usually necessary to clear frequent infections. The frequent infections cause scarring of the lungs.

Cystic fibrosis (CF) is an inherited disease which involves many organ systems. In the lungs, CF causes the sputum to be thicker than normal. This thick sputum allows bacteria to grow. As with bronchiectasis, patients will eventually have trouble getting all the air out of their lungs. Patients with CF may also have problems with their liver, pancreas, gastrointestinal tract, and reproductive systems.For both bronchiectasis and CF, one of the most common bacteria causing infections is Pseudomonas aeruginosa. This bacterium is often treated with two or more antibiotics. Over time the bacteria may resist the effects of many antibiotics. Some bacteria such as B.cenocepacia make the risks of transplant too great. Due to long term infections, many patients with bronchiectasis and CF need a double lung transplant.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that have one thing in common: a decreased ability to blow air completely out of the lungs. By far the most common cause of COPD is cigarette smoking.

Emphysema & Alpha-1 Antitrypsin Deficiency

Emphysema is a disease in which the lungs become injured causing loss of normal lung tissue, the formation of cysts, and abnormally large air sacs. These changes can lead to more airflow obstruction and air trapping. The more people smoke, the more likely they are to develop emphysema. Emphysema may also run in families that have Alpha-one antitrypsin deficiency. This genetic disorder may explain why some people develop this disease without long-term, frequent smoking.

There are no medications available to reverse the damage that occurs to the lungs from emphysema. The most important thing to do is to STOP SMOKING. There are inhaled and oral medicines that may improve symptoms. In addition,exercise programs (pulmonary rehabilitation) are often helpful in improving stamina and quality of life. Many patients can develop improved lung function overtime if they stop smoking. Patients considering lung transplant MUST be off cigarettes completely for at least one year before an evaluation for transplant will be scheduled.

Patients with COPD usually receive a double lung transplant, although a single lung transplant occasionally may be considered.

Restrictive Lung Diseases

Pulmonary Fibrosis and Sarcoidosis

Pulmonary fibrosis is the abnormal formation of scar tissue in the lungs. This disease process is characterized by the inflammation and scarring of air sacks in the lungs and in the tissue between the lungs, so the lungs become stiffer overtime.

Your doctor can advise you about therapies for pulmonary fibrosis. All pulmonary fibrosis patients are encouraged to start a pulmonary rehabilitation(exercise) program while awaiting transplant. Regular exercise with oxygen will train the breathing muscles to help make breathing easier. Patients who exercise regularly report an improved sense of well being.

Pulmonary sarcoidosis is characterized by the presence of granulomas (smallareas of inflamed cells) on the lung tissue. If pulmonary sarcoidosis progresses,inflammation can cause scarring leading to pulmonary fibrosis. Sarcoidosis may also spread to other organs including the heart. The treatment and rehabilitation plan is similar to the one mentioned above for pulmonary fibrosis.

Many patients with pulmonary fibrosis and sarcoidosis can be treated with medicines including supplemental oxygen and never require lung transplant. Fora few patients the disease progresses to a point where transplant may be an appropriate option. In rare patients pulmonary fibrosis progresses quite rapidly despite all treatment.

Pulmonary Hypertension

Pulmonary hypertension means that the blood pressure in the lungs is too high.High blood pressure in the lungs causes problems with the way oxygen gets in to the blood.

If you have pulmonary hypertension, it is important to discuss pulmonary rehabilitation with your physician. Exercise can make the blood pressure in your lungs even higher. It is important to try to keep the blood pressure in your lungs as low as possible.

Some patients with pulmonary hypertension may respond well to medicines.Your doctors and nurses will discuss whether medication may be an option for you.