Introduction
The immune system's diminished ability to react to foreign antigens, such as surface antigens on tumor cells, is known as immunosuppression. Immunosuppressive drugs are those that weaken the body's response to an immune stimulus or suppress the immune system. On the other hand, immunosuppression can result from the death of immune effector cells or from blockage of intracellular pathways that are critical for antigen recognition or other aspects of the immune response (Rice, 2019). Immunosuppressive medications are typically used to treat a variety of illnesses, including lupus, arthritis, myasthenia gravis, and glomerulonephritis. The five classes of immunosuppressive medications are: antibodies, glucocorticoids, cytostatics, medications that act on immunophilins, and other medications.
Lung transplantation overview
The surgical process of replacing damaged lungs with healthy donor lungs is known as a lung transplant or lung graft. Those with lung illness who have not improved after medication or other treatments are typically candidates for this operation.
To treat patients with lung disease, three types of lung transplants are generally carried out, including:
A single lung transplant is a surgical operation used to replace one diseased lung with a healthy one.
A double lung transplant is a surgical technique used to replace both damaged and healthy lungs with new ones. COPD or cystic fibrosis can be treated with this treatment.
A heart-lung transplant is a surgical operation in which a healthy donor heart and lung are swapped out simultaneously. Usually, severe pulmonary hypertension is treated with this treatment.
At what point is a lung transplant required?
Advanced lung illness that does not improve even after having other forms of treatment may be treated with lung transplants. Furthermore, patients who, in the absence of a transplant, have a life expectancy of less than 2-3 years are advised to have this treatment done. Following a lung transplant, the following medical issues can be treated:
Chronic obstructive pulmonary disease (COPD), which includes emphysema.
Cystic fibrosis.
Pulmonary hypertension.
Idiopathic pulmonary fibrosis is a condition when there is increasing scarring in the lungs due to an unidentified reason.
Lung transplant contraindications
Please be aware that not everyone is eligible for a lung transplant. This medical technique has both absolute and relative contraindications. Relative contraindications are medical problems for which a specific procedure might not be advised, but in certain cases, a doctor may still consider it if the advantages are thought to exceed the dangers.
Among the relative disqualifiers for lung transplantation are:
Older than 65 years old.
Type I obesity.
Severe malnourishment.
Significant osteoporosis.
History of lung resection and significant thoracic surgery.
Patients receiving life support or mechanical ventilation.
Colonization by highly resistant or virulent bacteria, viruses, or fungi.
Individuals without cirrhosis or portal hypertension who have been infected with hepatitis B
Patients with controlled HIV (adherent to treatment and undetectable HIV-RNA).
Patients with coronary heart disease.
Patients with diabetes mellitus, systemic arterial hypertension, epilepsy, GERD, or peptic ulcer.
An absolute contraindication is a circumstance in which a specific technique is wholly unwise. Among the disqualifications are:
Individuals with a history of cancer, particularly if they haven't had cancer for more than five years.
Individuals have severe problems with their hearts, livers, brains, or kidneys.
Individuals with ischemia of the target organ who have coronary heart disease.
Unstable medical circumstances, such as those involving heart failure, myocardial infarction, or acute sepsis patients.
Blood problems left untreated.
Unwilling to alter your way of life after receiving a transplant, such as keeping up with alcohol consumption and smoking.
Lack of social support, as you will require extensive post-procedure care following the transplant.
Experiencing drug addiction or psychiatric issues.
Procedure for Lung Transplantation:
Preparation, the transplant procedure, and post-surgical care are the three main phases of a lung transplant.
1. Preparing for a Lung Transplant
Prior to receiving a lung transplant, patients must have tests done on critical organs such the liver, kidneys, and heart. Additionally, patients are counseled to alter bad lifestyle choices, such as quitting smoking and, if obese, decreasing weight.
The patient can then be registered by the doctor to be placed on a waiting list for a suitable organ donor. To guarantee that the receiver of the lung organ is compatible with the donor, a variety of requirements must be fulfilled, such as:
Blood type
The donor's chest cavity and lung capacity are contrasted.
The state of health of the donor recipient.
The transplant recipient's location and the donor organ's location.
The extent of the recipient's pulmonary illness after donation.
Transplant success percentage.
2. The Process of Lung Transplantation
It normally takes 6 to 8 hours for a lung transplant, depending on how involved the surgery is. In the lung transplant operation, the following are the stages that the physician will take:
To assist the patient in breathing, insert a tube into their throat and nose.
Administering general anesthetic to help the patient lose consciousness and stop feeling discomfort.
Putting in a heart and lung bypass machine to keep the patient's blood flowing properly throughout the surgery.
Make a cut in the chest to extract the injured lung organs.
The surgeon will next insert healthy lungs into the patient's chest cavity and attach them to the blood vessels and breathing system.
The surgeon can use special suture threads to seal the chest incision if the replacement lung is operating as intended.
3. Lung Transplant Postoperative Care
Following the completion of the transplant process, the patient will spend several days in the intensive care unit (ICU) and will require a ventilator to aid in breathing. The patient will spend one to three weeks in a regular treatment room in the hospital if they are no longer on a ventilator. The patient must continue to do routine control for three months after being cleared to return home in order to account for any potential problems. Aside from that, following a transplant, patients must also alter their lifestyles to include:
Take the immunosuppressive medications that your doctor has prescribed on a regular basis to prevent the body from rejecting the new organ.
Consume nutritious, well-balanced food.
Avoid alcohol consumption and smoking.
In order to keep your target body weight, exercise frequently.
For psychological assistance, connect with other beneficiaries of organ transplants.
Adverse Reactions to Lung Transplantation
The process of lung transplantation carries a significant risk. Infection and the body's reaction of rejection to the new organ are common post-lung transplant problems.
The body will be shielded against foreign chemicals by the immune system. The receiver and lung donor have a very high degree of compatibility, yet the new lungs may still be attacked and rejected by the immune system. The risk of rejection is greatest just after a lung transplant and then gradually declines.
Immunosuppressive medications are required for life in order to prevent this rejection reaction in organ transplant recipients. But using this medication can also have a number of negative consequences, including:
Gaining weight.
Regurgitation.
Prone to infection, particularly in developing organs.
At risk of getting long-term conditions including diabetes, high blood pressure, or osteoporosis.
Some of the adverse effects of a lung transplant, aside from the possibility of a rejection reaction, are as follows:
Malfunction of the primary graft (PGD).
Thromboembolism in veins.
Nerve damage.
Problems related to the pleura.
Vascular anastomoses (connections between blood vessels) and their complications.
Issues with airway anastomosis.
Organ refusal.
Post-transplant malignancy.
Written by Keni
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