Deciding on a transplant is a difficult and serious step. All available conservative treatment options must be exhausted. It is necessary to realize that the transplant itself is an extensive surgical intervention that poses a significant risk. Therefore, it is necessary to accurately and correctly determine in which patients the pulmonary impairment and the overall quality of life have deteriorated to such an extent that the risks associated with this condition exceed the potential risks of surgery. Even the regime after surgery is binding: life-long immunosuppressive treatment with all its side effects, respiratory rehabilitation, regular check-ups in the hospital, higher risk of infectious complications, diabetes and more. With a lung transplant, you exchange one serious disease that would kill you within a few months for another that allows you to breathe and live for many years. There are a number of end-stage lung diseases that can be treated with a lung transplant. Each disease has its differences, and these bring specific risks and complications. The long-term results of the transplant and the survival time, which is different for different diseases, also depend on them. The underlying disease also determines what type of surgery will be performed. There are a total of three surgical options: unilateral lung replacement, bilateral lung replacement and, in limited cases in pediatric patients, lung replacement with a single lobe from a living donor.
Unilateral lung transplantation
At present, we perform unilateral lung transplantation very exceptionally. Unilateral lung transplantation is the method of choice for chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). It is also performed in alpha-1 antitrypsin deficiency, lymphangioleiomyomatosis, sarcoidosis or as a retransplantation in bronchiolitis obliterans based on chronic rejection.
Bilateral lung transplantation
In our center, bilateral lung transplantation is the method we choose for most patients with a basic diagnosis:
- chronic obstructive pulmonary disease
- idiopathic pulmonary fibrosis
- primary arterial pulmonary hypertension
- lymphangioleiomyomatosis
- cystic fibrosis
Lung lobe transplantation
Lung lobe transplantation is rarely indicated in pediatric patients or small adult recipients. One lung lobe from a living adult donor is transferred to the affected lung site.