Lung Transplantation

The lung transplantation is very complicated life saving surgery. It is usually the last kind of therapeutic procedure by patients in end stage of lung disease (COPD, bronchiolotis obliterans). The lung can be replaced partialy or totaly or totaly with heart. The first lung transplantation was performed by James Hardy in 1963, the patient died after 18 days. The patients in 2011 have chance to live longer than 20 years.

Epidemiology
Over 1700 patients in the world undergo this surgery every year. The median waiting time to transplantation is over 1000 days.

Heart lung transplantation
The complex of heart and lung is removed from one dead donor. Indications include heart and lung diseases − lung parenchyma disability associated with impairment of myocardium or inoperable valve disease.

Bilateral lung transplantation
The lungs are removed from dead donor. Indications are idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), α1-antitrypsin deficiency emphysema.

Single lung transplantation
The lung is removed from dead donor. Indications are COPD, bronchiolitis obliterans, emphysema.

Lobe transplantation
The lobe is removed from living donor, ussualy donors. The donors must be screened, that they will have normal quality of life after resection.

Indications
The indication for the lung transplantation usually is end-stage of lung disease which includes chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), α1-antitrypsin deficiency emphysema and primary pulmonary hypertension (PPH). The most often indication for lung transplantation generally(includes single and bilateral lung transplantation) is COPD (38,5 %), the second most often indication is IPF (17,4 %) and CF (16,6 %). The most often indication for bilateral lung transplantation is CF (31,9 %).

Contraindications
Absolute contraindications include :
 * serious kidney or liver dysfunction;
 * active extrapulmonary infection;
 * current abuse of narcotics, alcohol or tobacco;
 * progressive neuromuscular didease;
 * active malignacy in last 2 years (but in special cases more than 5 years − melanoma level III and higher, coon cancer higher than Duke A, breast cancer stage 2 and higher and extracapsular renal tumors).

Relative contraindications are :
 * medical condition of the patient;
 * endstage organe damage;
 * systemic hypertension;
 * diabetes mellitus;
 * peptide ulcer disease.

Other risk factors are:
 * osteoporosis → post-transplant bone fractures;
 * morbid obesity or cachexia → is associated with increased postoperative mortality.