Lung Transplant

Single Lung Transplant

• Surgical scar: Presence of a well-healed or healing thoracotomy scar from the single lung transplant.

• Physical examination may be normal

• Findings you may find for the underlying cause:

  • Idiopathic pulmonary fibrosis (IPF):

    • Clubbing: Abnormal enlargement of fingertips.

    • Fine crackles: Discontinuous, short, high-pitched sounds, often described as "Velcro-like," typically heard at the lung bases.

  • Chronic obstructive pulmonary disease (COPD) or emphysema:

    • Barrel-shaped chest, pursed-lip breathing, use of accessory muscles, hyperresonance on percussion, wheezing.

  • Alpha-1 antitrypsin deficiency:

    • Signs of emphysema or COPD (as described above).

    • Jaundice: Yellowing of the skin and eyes due to liver involvement.

Double Lung Transplant

• Surgical scar: Bilateral thoracotomy scar or a clam-shell scar for the double lung transplant

• Physical examination may be normal

• Findings you may find for the underlying cause

  • Cystic fibrosis:

    • Clubbing (reversible)

    • Dextrocardia (Kartergener’s syndrome)

  • Pulmonary arterial hypertension:

    • Peripheral oedema: Swelling of the extremities, particularly the ankles and feet, due to fluid accumulation.

    • Jugular venous distention: Visible or palpable distention of the jugular veins, indicating increased central venous pressure.

Causes of Lung Transplant

• Single Lung Transplant: Dry lung condition such as interstitial lung disease, COPD

• Double Lung Transplant: Wet lung condition such as cystic fibrosis, COPD, and pulmonary artery hypertension

Complications of Lung Transplantation

• Infection:

  • Bacterial, viral, or fungal infections.

• Rejection:

  • Acute rejection: Fever, dyspnea, hypoxia, infiltrates on chest imaging.

  • Chronic rejection: Gradual decline in lung function, bronchiolitis obliterans syndrome (BOS).

• Bronchiolitis obliterans syndrome (BOS):

  • Progressive decline in lung function.

  • Manifests as obstructive lung disease.

• Post-transplant lymphoproliferative disorder (PTLD):

  • Lymphocyte proliferation caused by immunosuppressive therapy..

  • Risk factors: Epstein-Barr virus (EBV) infection, high levels of immunosuppression.

• Graft-versus-host disease (GVHD):

  • Donor immune cells attack recipient tissues.

• Primary graft dysfunction (PGD):

  • Acute lung injury within 72 hours of transplant.

• Airway complications:

  • Airway stenosis, malacia, or dehiscence.

• Vascular complications:

  • Pulmonary artery or vein stenosis, thrombosis, or kinking.

• Renal dysfunction:

  • Nephrotoxicity from calcineurin inhibitors.

• Malignancy:

  • Increased risk due to immunosuppressive therapy.

• Osteoporosis:

  • Bone loss due to immunosuppressive therapy, especially corticosteroids

Side effects of Immunosuppressive Medications

• Calcineurin inhibitors (e.g., tacrolimus, cyclosporine):

  • Nephrotoxicity: Kidney damage or impaired function.

  • Hypertension: Elevated blood pressure.

  • Neurotoxicity: Tremors, headaches, seizures.

  • Hyperglycemia: Elevated blood sugar levels, increased risk of diabetes.

  • Gastrointestinal symptoms: Nausea, diarrhoea, abdominal pain.

• Antiproliferative agents (e.g., mycophenolate mofetil, azathioprine):

  • Bone marrow suppression: Anemia, leukopenia, thrombocytopenia.

  • Gastrointestinal symptoms: Nausea, vomiting, diarrhoea, abdominal pain.

  • Hepatotoxicity: Liver damage or impaired function.

• Corticosteroids (e.g., prednisone):

  • Weight gain: Increased appetite leading to obesity.

  • Cushingoid features: Rounded face, fat deposits on the back and abdomen.

  • Osteoporosis: Bone thinning and increased fracture risk.

  • Hyperglycemia: Elevated blood sugar levels, increased risk of diabetes.

  • Hypertension: Elevated blood pressure.

  • Increased risk of infection: Due to suppression of the immune system.

  • Mood changes: Depression, anxiety, irritability, insomnia.

• mTOR inhibitors (e.g., sirolimus, everolimus):

  • Hyperlipidemia: Elevated cholesterol and triglyceride levels.

  • Bone marrow suppression: Anemia, leukopenia, thrombocytopenia.

  • Nephrotoxicity: Kidney damage or impaired function.

  • Gastrointestinal symptoms: Nausea, diarrhea, abdominal pain.

  • Interstitial lung disease: Inflammation and scarring of lung tissue.