Fall 1998 ~ Newsletter
Cystic Fibrosis and Lung Transplants
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Questions Commonly Asked About Lung Transplants
By David McGiffin, MD
Q. What types of lung transplant procedures can be performed on patients with cystic fibrosis?
In the United States, patients with cystic fibrosis undergoing lung transplantation almost exclusively receive bilateral (double) lung transplants. Single lung transplantation is not applicable to patients with cystic fibrosis because of the chronically infected nature of cystic fibrosis lungs. If a single lung transplant was performed in a patient with cystic fibrosis and a native lung was retained, the new grafted lung would be contaminated from the native lung. In other countries, in particular, Great Britain, there is extensive experience of heart / lung transplantation for cystic fibrosis. There are no advantages of heart / lung transplant over bilateral lung transplantation; hence, bilateral lung transplantation is preferred, which has the additional advantage of providing a heart for another recipient for cardiac transplantation.Q. In which patients with cystic fibrosis is lung transplantation recommended?Lung transplantation is recommended in patients with cystic fibrosis for improvement in quality of life and prolongation of life. The specific complications of lung transplantation in patients with cystic fibrosis are severe disorders of other systems, and resistant organisms in the sputum (multi-resistant organisms are not necessarily a complication), and excessive loss of physical and nutritional reserves. Previous thoracic surgical procedures including talc pleurodesis are not a contraindication to lung transplantation.
Q. When should patients with cystic fibrosis be referred for consideration for a lung transplant?Patients with cystic fibrosis should be considered for lung transplantation when there is progressive decline in lung function - normally below 30% of predicted, increasing frequency of hospitalizations and decreasing weight despite nutritional support.Q. What can the patient do while waiting for lung transplantation?It is important for the patient to keep in close contact with the primary pulmonary care team as well as the lung transplant team. Particular issues may require attention, including prompt treatment of infection, early treatment of respiratory failure in particular to avoid intubation and ventilation (the results of lung transplantation are poor in this setting), nutritional support (including, if necessary, a gastrostomy tube), and encouraging mobility. Waiting for a lung transplant can be a very stressful time and it is very important that the patient receives support from within the cystic fibrosis community and the lung transplant community. This can be extremely helpful, particularly when the waiting time becomes prolonged.