HEART-LUNG TRANSPLANT

A heart-lung transplant is a procedure during which a person’s heart and lungs are replaced with those of another person. Such surgeries are complicated, and there is a limited number of patients eligible for them. A heart and lung transplant is indicated when a person has diseases of both organs that require their combined replacement. This article discusses the indications for a heart and lung transplant, preparation for it, the surgery itself, and post-transplant care and rehabilitation, as well as possible complications after it.

Heart-Lung Transplant Indications

In general, a heart-lung transplant is indicated in the case of reduced pumping function of the heart and lungs. At the same time, a transplant of one of these organs is indicated if their transplantation alone will not allow returning the function of the other one to normal. The reasons for a heart and lung transplant may include several diseases:

Primary pulmonary hypertension

This disease is characterized by high pulmonary pressure that leads to right ventricular failure. Sometimes, it is complicated by heart and lung damage, so a transplant is indicated.

Cystic fibrosis

This disease is genetic and causes lung insufficiency with consequent right heart failure. In addition, a transplant of both organs is indicated for some patients due to the course of this disease.

Eisenmenger syndrome

It leads to congenital heart defects with pulmonary hypertension and lung damage; therefore, a transplant of both organs is indicated.

Pulmonary vascular disease

Due to the damage to the blood vessels in the lungs, this disease leads to the malfunction of both the heart and lungs. Moreover, this diagnosis is also an indication for a heart-lung transplant.

Congenital heart defect

Sometimes patients are born with heart defects and at the same time have lung disease; in this case, a transplant is indicated.

Cardiomyopathy with pulmonary involvement

It is indicated for cardiomyopathy that leads to pulmonary hypertension.

Evaluation for Heart-Lung Transplant

Prior to a heart-lung transplant, several tests are necessary to determine whether a person is eligible for one. In addition, evaluation for this type of transplantation is similar to evaluation for a heart or lung transplant alone; however, in this case, the functions of both organs are studied more carefully.

Medical history and physical exam

A doctor examines a patient and studies his medical history to assess his general health, as well as the state of his heart and lungs.

Pulmonary function tests

They are indicated to determine the volume of air a person can inhale and exhale to assess the lungs’ function.

Cardiac assessment

To study the functions of the heart, a doctor may prescribe a set of tests, such as echocardiography (EKG), cardiac catheterization, and MRI. 

Imaging

X-ray, CT scans, or MRI may be indicated to study the structure of the heart and lungs.

Lab tests

Lab tests are indicated to assess the function of other organs, such as the liver and kidneys, as well as to find out whether a patient has infections.

Psychosocial assessment

A psychosocial assessment is necessary to find out whether a patient is psychologically ready for a transplant and will be able to follow all recommendations after it.

Waiting list

If a person is found to be eligible for a heart and lung transplant, he will be placed on a waiting list. The time spent on the waiting list varies from patient to patient and depends on many factors, such as the general state of health, the availability of donor organs, and the urgency of the transplant.

Heart-Lung Transplant Surgery

A heart-lung transplant surgery is a complex procedure because it involves transplanting two organs at once: the heart and the lungs. Thus, a heart and lung transplant surgery usually takes 8-12 hours. Throughout this time, a surgeon will extract the damaged heart and lungs and replace them with those of a donor. The patient will receive anesthesia prior to the surgery. In addition, a common sternotomy or clamshell incision will be made to access the heart-lung. Thereafter, the surgeon will remove the damaged heart and lungs, taking care not to damage the vessels and tissues. After that, he will remove the damaged organs from the patient and put the donor heart and lungs into his chest. Thereafter, the vessels are connected to the donor heart and lungs, and blood circulation is established. Then the doctor checks whether the transplanted organs are working properly. After that, the incision is sutured.

Post-Transplant Care

After a heart and lung transplant surgery, a patient will have to spend several weeks in the hospital. Throughout this time, he will receive special care to ensure the proper functioning of his transplanted organs.

Immunosuppressive drugs

After the transplant, a patient will have to take immunosuppressive drugs to ensure that his immune system does not reject the donor heart and lungs. Immunosuppressive drugs suppress the activity of the immune system, reducing its ability to resist foreign proteins, such as those present in the donor heart and lungs. Thus, immunosuppressive drugs significantly reduce the body’s ability to fight infections, increasing the risk of developing them several times after the transplant. To reduce the risk of infection after a heart and lung transplant, a doctor may prescribe antibacterial, antiviral, and antifungal drugs.

Monitoring after a Heart-Lung Transplant

To monitor the state and functionality of the transplanted heart and lungs, regular tests and procedures are necessary after a heart-lung transplant. After such a transplant, a patient will have to periodically visit the hospital for tests and procedures to determine how well the transplanted organs work and to determine any complications after the transplant. Some of these tests are performed in hospitals, and some – at home. For example, regular pulmonary function tests, cardiac tests, bronchoscopy, and biopsy can be examples of such procedures. Monitoring the function of the transplanted lungs and heart after a heart and lung transplant is crucial to determine the state of the donor organs and detect any complications in the early stages.

Rehabilitation

After a heart and lung transplant, a patient has to rehabilitate to improve his lung function and overall health. It is vital to develop a personalized rehabilitation plan for each patient because the state of health and the course of rehabilitation after the transplant depends on several factors, such as the state of health prior to the transplant, the course of the transplant surgery, and the state of health after it. The rehabilitation process may include, for example, special breathing exercises or participation in a special cardiac or pulmonary rehabilitation program.

Emotional and psychological support

Many patients after a heart and lung transplant will need emotional or psychological support after the transplant. It is vital to remember that a heart and lung transplant will significantly change a person’s life. In addition, after such a transplant, a person will have to take immunosuppressive drugs for the rest of his life in addition to making dietary and lifestyle changes. Accordingly, it is vital for loved ones of the transplant recipients to provide comprehensive psychological and emotional support to the transplant survivors.

Complications of Heart and Lung Transplants

Organ rejection

Organ rejection is the most common transplant complication that can occur after almost any transplant. It is vital for the recipient to be monitored by his doctor after a heart and lung transplant to detect any signs of organ rejection. Although immunosuppressive drugs reduce the likelihood of organ rejection, they cannot prevent it. Organ rejection can be acute or chronic. Acute organ rejection after a heart and lung transplant usually occurs within three to six months after the transplant, while chronic one – later.

Infections

Infections are also a common and serious complication after a heart and lung transplant. After such a transplant, patients are especially vulnerable to bacterial, viral, and fungal infections because their immune systems are suppressed due to immunosuppressive drugs. In addition, infections complicate the recovery process after a transplant. Accordingly, they are one of the most dangerous transplant-related complications, and their occurrence is rather common after a heart and lung transplant. Furthermore, lung transplants, and thus heart-lung transplants, are also associated with an increased risk of fungal infections.

Chronic lung allograft dysfunction

Chronic lung allograft dysfunction is one of the most devastating and common complications after a lung transplant, resulting in progressive insufficiency of the transplanted lungs. Chronic lung allograft dysfunction significantly decreases the quality of life after a lung transplant and is frequently fatal.

Cardiac allograft vasculopathy

Cardiac allograft vasculopathy is a chronic rejection of the transplanted heart that is similar to atherosclerosis. This complication is characterized by the thickening of the coronary arteries of the transplanted heart. Unfortunately, cardiac allograft vasculopathy is untreatable.

Bleeding and clotting

Heart and lung transplant complications also include bleeding and clotting. Hemorrhagic complications after transplantation are among the most dangerous post-transplant complications because they can lead to pulmonary embolism, stroke, and other dangerous conditions.

Cancer

Unfortunately, a heart and lung transplant can also lead to an increased risk of developing various cancers, such as skin cancer and lymphoma. This is due to the reduced performance of the immune system due to immunosuppressive drugs that a transplant recipient will have to take for the rest of his life after the transplant. Accordingly, after a heart and lung transplant, the risk of developing skin cancer, lymphoma, and other cancers increases.

Dysfunction of other organs

A heart and lung transplant can also lead to the development of dysfunction of other organs, such as the kidneys and the liver.

Survival Rates After a Heart and Lung Transplant
A heart and lung transplant is a procedure that allows patients with severe lung disease to survive. According to recent studies, approximately 75-80 percent of patients survive the surgery itself, while 85-90 percent of them survive the first year after the transplant. In addition, 55-65 percent of transplant survivors live for five years after the transplant, while 35-40 percent of them live for ten years after the transplant. Overall, a heart and lung transplant gives patients with severe lung disease and heart disease a good chance to prolong their lives as there are few other methods to manage these conditions.