Introduction
Although lung transplantation has emerged as a crucial method for treating advanced respiratory diseases, patient survival rates are lower than those after a solid organ transplant. As a result, the main indicator of success in most research has been patient survival. Pulmonary function (working of the lungs), quality of life, etc., are the other indicators studied.
What Is Lung Transplantation?
When end-stage lung disease and respiratory failure occur, lung transplantation has been a life-saving procedure for carefully selected patients. When there is a worsening condition in an end-stage lung disease despite receiving the best care, patients are referred for a lung transplant. After a thorough examination and a long waiting time, most patients receive a lung transplant on an elective basis while getting the best disease-specific care at home until a donor's lung is available.
A surgery done to replace the diseased or damaged lung with a healthy donated lung is called a lung transplant. There are three main types of lung transplant. They are:
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Single Lung transplant: In this procedure, a damaged lung is replaced with a healthy lung from the donor.
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Double Lung Transplant: Both lungs are replaced by the donor lungs in this procedure.
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Heart Lung Transplant: The diseased heart and lungs are replaced with healthy organs from a donor in this procedure.
What Are the Advantages of a Lung Transplant?
A lung transplant improves the overall quality of life of the patient. The advantages of a lung transplant can include:
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Increased Lifespan: Studies show that about fifty-five percent of lung transplant cases survive at least five years. However, many patients have lived ten to fifteen years post-transplant.
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Increased Energy: A lung transplant enables the patient to breathe more freely. Hence, they have more energy to do daily activities.
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Increased Fertility: Studies show the fertility rate improved after a lung transplant. However, the relationship between lung transplants and fertility is still debatable.
What Is the Survival Rate of the Lung Transplant Patient?
The International Society for Heart and Lung Transplantation (ISHLT) has recorded data of more than fifty-five thousand adult patients who had received a lung transplant from over two hundred and fifty transplant centers, starting from the 90s. It provides information on lung transplant activity and their outcomes.
According to research done in 2016, the median survival rate of patients who underwent primary lung transplants between January 1990 and June 2014 was 5.8 years. The median post-transplant survival has increased over some time. It rose from 4.2 in 1990 to 1998 to about 6.1 in 1999 to 2008. It is remarkable that despite a significant change in the patient’s features and severity at the time of a patient’s transplant, the posttransplant survival rates kept rising. The number of people over 65 has increased, and cases requiring mechanical ventilation have doubled. Although there were similar advancements, the survival rates for lung transplant recipients are still lower than for recipients of other solid organ transplants.
The underlying conditions or diseases are one of the key factors influencing the outcomes of lung transplantation. The age, presence of other comorbidities, and habits like smoking also influence the outcome of a lung transplant. Other factors that have a role in determining the outcome can depend on the patient and the donor. Depending on the patient, those factors can include age, gender, and whether the patient is under mechanical ventilation, dialysis, or hospitalized in the intensive care unit (ICU). The factors that depend on the donor can be their age, gender, diabetes, exchange of gases at the time of harvest, and the reason for death. The interaction between the donor and the recipient, like the number of HLA (human leukocyte antigen) mismatches, gender mismatch, etc. The surgical approach taken, whether single or bilateral, can also be a factor in determining the outcome of the transplant. Most of these factors can not be altered. However, the surgical approach can be altered. Hence, an appropriate approach must be chosen after considering the other risk factors.
How Is the Quality of Life of the Patient After a Lung Transplant?
Improving the patient's quality of life is one of the main goals of a lung transplant. The quality of life following a lung transplant may also depend on the patient's financial status, social support, physical environment, and health. Many instruments are available to measure the health-related quality of life (HRQoL). Some of these instruments are generic, while others are disease-specific. They may have many advantages and limitations. However, they do not follow the same criteria of evaluation. As a result, they will not be able to provide a similar estimation of the transplant outcomes.
How Does the Patient’s Pulmonary Function Test Go After a Lung Transplant?
A patient's pulmonary function after a lung transplant depends on factors like underlying conditions before the transplant, operative factors like injury in the pleura or the diaphragm, and complications after the procedure like bronchial strictures. Pain and early graft dysfunction may hamper pulmonary functions. Peak pulmonary function test values can be achieved about three to twelve months after the transplant. However, the average function can decline after some time due to chronic lung allograft dysfunction (CLAD). It is the most common cause of mortality in lung transplant patients within the first year. The pulmonary function can also depend on the patient's occupation, whether the patient is working, the geographical area, etc.
Conclusion
In conclusion, a lung transplant allows more room for improvement in the functioning of the lungs, exercise tolerance, and better quality of life. The improvement in the quality of life far exceeds that of many treatments for end-stage lung diseases. The survival rates are also improved following a lung transplant. However, it can be affected negatively by CLAD in some cases.
