Lung Transplantation

Indications

Single Lung Transplantations

Emphysema
Idiopathic pulmonary fibrosis
Alpha-1 antitrypsin deficiency
Sarcoidosis
Langerhans cell histiocytosis
Chronic hypersensitivity pneumonitis
Lymphangioleiomyomatosis
Drug-induced pulmonary fibrosis

The only absolute contraindications to single lung transplantations are chronic pulmonary sepsis and uncorrectable cardiac defects.

Bilateral Lung Transplantations

“Septic” lung diseases such as cystic fibrosis and bronchiectasis
Primary pulmonary hypertension

Heart-Lung Transplantations

Uncorrectable congenital heart disease

Complications

Table 61.1 provides an overview of the complications associated with lung transplantation.

Lymphoproliferative Disorders

The spectrum of expression ranges from a mild, benign polyclonal proliferation of lymphatic tissue with few if any signs and symptoms to non-Hodgkin’s lymphoma. The incidence of post-transplant lymphoproliferative disorders (PTLD) after lung transplantation ranges from 6.2 to 9.4% and is twofold higher than what is seen after transplantation of other organs. Almost all cases of this disorder result from a combination of Epstein-Barr virus (EBV), stimulation of B-lymphocyte proliferation associated with a cyclosporin-inhibited regulatory mechanism of T-lymphocyte proliferation. A higher incidence of PTLD in children as compared with adults has been attributed to a greater susceptibility to EBV infection. A unique feature of this entity is that lymphoid masses may regress or disappear when immunosuppressive therapy is stopped or reduced.

Intrathoracic PTLD is most commonly characterized by the presence of discrete nodules, more often multiple than solitary. The nodules are frequently distributed in peribronchovascular and subpleural locations involving the lower and middle lung zones. The intrathoracic computed tomography (CT) findings of PTLD are similar in immunocompromised patients with or without AIDS and are usually extranodal. Less frequently, mediastinal or hilar lymph node enlargement can be a manifestation of PTLD. Thymic, pericardial, and pleural involvement has also been reported.

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