Single- and Double-lung Transplantation

Abstract

There is a resurgence of interest in single- and double-lung transplantation for end-stage disease. An experience with six double-lung and three single-lung transplants is reported. The lungs were procured from a distance of up to 600 miles and the heart was shared with another team for transplantation in seven of nine instances. The operative mortality rate was 33%. Early transplant infections of donor origin were lethal. Late transplant pneumonitis was well tolerated and recovery was the rule. Three of nine cases had significant tracheal suture line stenosis and were managed conservatively. A technique of bronchial artery implantation using a conduit tailored from donor aorta is described. Transplant rejection was easily diagnosed and treated. Other notable complications included occasional massive pleural fluid loss, temporary space problem, and a delay in the 'resetting' of chemoreceptors resulting in moderate post-transplant hypercarbia accompanied by episodes in which the patient felt hypoxemic despite the maintenance of excellent levels of blood gases. A comprehensive rehabilitation program begun before operation is essential for success.

The pleural space and organ transplantation.

“…One early series of 10patients (147) reported a 100070 incidence of pleural effusion after heart-lung transplantation. These effusions are usually small to moderate in size (Figure 1), but rarely may be massive (148). Most resolve spontaneously within 14 d after the transplantation, although a small percentage may increase in sizeover the first 3 postoperative weeks (147).…”

“…Infected pleural effusions and empyemas with Legionella species (161), Staphylococcus and streptococcal species (162), Pseudomonas aeruginosa (148), Mycobacterium tuberculosis (163,164), and Candida (165) have also been reported in lung and heart-lung transplant recipients.…”

Pulmonary Rehabilitation in Lung Transplantation

“…Postoperatif erken dönemde hastaların inspiratuar kuvvetleri nispeten kompliansı düşük akciğerleri ventile etmeye yetmeyebilir. Bu nedenle hastaların çoğu solunum hızı yüksek olan ve yardımcı solunum kas aktivitesine ihtiyaç duyduk ları bir solunum paterni geliştirir (23). Bu durum ile birlikte anksiyete de görülebilir.…”

Revascularization of trachea in lung and tracheal transplantation

“…have reported the anastomotic technique using donor BA and recipient ITA conduit is acceptable (6). Other investigators have suggested interesting techniques of direct revascularization of the BA using a saphenous vein (SV) conduit (7) or a conduit of the tailored aorta (8) or by direct reimplantation into the recipient aorta after dissecting out a pedicle of the BA (9). However, SV is inferior in late patency of the conduit to ITA.…”