Heart-and-lung transplant

Alternative names
Transplant - heart and lungs

Definition
This surgery replaces a diseased heart and lungs with a healthy heart and lungs from a human donor.

Description
Heart-and-lung transplant operations have been performed since 1980 in the United States. In 1997, approximately 150 of these operations were performed. The donated heart and lungs are from a person who has been declared brain-dead, but remains on life-support. Tissue matches must be performed to assure the patient’s best chance of not rejecting the transplanted organs.

While the patient is deep asleep and pain-free (general anesthesia), an incision is made through the breast bone (sternum). Tubes are used to re-route the blood to a heart-lung bypass machine. This keeps the blood oxygenated and circulating during the surgery.

The patient’s heart and lungs are removed, and the donor heart and lungs are stitched into place.

Indications
Heart-lung transplant may be recommended for patients with:

Heart-and-lung transplants are not recommended for patients who have decreased kidney or liver function, insulin dependent diabetes mellitus, or other serious diseases.

RISKS
Risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery are:

     
  • Bleeding  
  • Infection

Additional risks of transplant includes:

     
  • Failure of the transplanted organs  
  • Rejection of the transplanted organs  
  • Infection due to anti-rejection (immunosuppression) medications  
  • Blood clots (Deep venous thrombosis)  
  • Stroke

Expectations after surgery

A heart-and-lung transplant prolongs the life of a patient who otherwise would die. The operation is done only when there is a very good chance of success. While long-term outcomes are unknown at this time, 5-year survival is approximately 40-50%.

As with all major organ transplants, the problems are finding a donor, preventing rejection, and the cost of the surgery and anti-rejection medications.

Finding a donor for heart-lung transplant can be difficult. The donated organs must come from a person who has been declared brain-dead, but is still on life-support, while the patient is still in healthy-enough condition to survive the surgery.

Preventing rejection is an ongoing process. The body’s immune system considers the transplanted organs as invaders (much like an infection), and fights them.

To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids) that reduce (suppress) the body’s immune response and reduce the chance of rejection. These drugs also reduce the body’s natural ability to fight off various infections.

Convalescence
An extended hospital stay should be expected. The recovery period is about 6 months. Frequent check-ups with blood tests and X-ray tests will be necessary for years.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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