This document discusses lung transplantation, including indications, contraindications, procedures, management, and follow up. It provides details on types of lung transplants including single lung, double lung, and living donor lobar lung transplantation. Requirements for donors and recipients are outlined. The document also discusses lung transplantation practices and outcomes in Saudi Arabia, noting that the first program began in 2003 and has performed over 70 transplants, limited by lack of organ donors.

1. Fay Ali AlBuainain
Respiratory Care Department
University of Dammam

2. Introduction
Indications
Contraindications
Criteria for eligibility
Requirements for donors and recipients
Medical tests
Description of procedure
Management
Follow up
Lung transplantation in Saudi Arabia

3. • lung transplantation has become an available
treatment option for patients with end-stage
lung diseases.
• In 1981, the first successful heart-lung
transplantation was performed for idiopathic
pulmonary arterial hypertension performed
by Dr. Bruce Reitz of Stanford University.

4. • A lung transplant is surgery done to remove a
diseased lung and replace it with a healthy
lung from another person.

5. Types of
Transplants
Cadaveric
Transplant
Single lung
Double
lung
Bilateral
sequential
Heart-lung
transplant
Living
Transplant
Lobe

6. • Severe cystic fibrosis (CF)
• COPD
• PHTN
• IPF
• Bronchiectasis

7. Absolute contraindications to
lung transplantation
 Malignancy.
 Organ faliure.
 Noncurable systemic infection
(HIV).
 Severe chest wall or spinal
deformity .
 Documented nonadherence.
 Untreatable psychiatric.
 Absence of social support
system.
 Substance addiction.
Relative contraindications to
lung transplantation
 Age > 65 years.
 Unstable clinical condition.
 Severely limited functional
status.
 Obesity.
 Mechanical ventilation.
 Colonization with highly
resistant organism.
 Severe osteoporosis.
 Significant medical problems
that may be difficult to control
(e.g., DM, GERD).

9. Donor characteristics:
 Healthy.
 Size match.
 Age.
 Blood type.
Recipient characteristics:
 End stage lung disease.
 No other chronic medical
condition.
 Acceptable psychological
profile.
 Financially able to pay for
expenses.

10. • Blood typing
• Tissue typing
• CXR
• PFT
• CT
• ECG
• Bone mineral density scan
• Cardiac stress test

11. • Single lung transplantation is performed
through a standard thoractomy with patient
under general anesthesia.
• ECMO is not always necessary for a single lung
transplant.

12. • Double lung transplantation involves
implanting the lungs as 2 separate lung and
ECMO is required.
• The patient’s lung/lungs are removed and the
donor lungs are stitched into place.

14. • Epidural analgesia
• Fluid Management:
– Maintenance of urine output at 0.5 ml/kg/hr
– CVP of 4-14mmHg
• Immunosuppressant
• Antibiotics
• Mechanical Ventilation:
– lung protective ventilatory strategy
• PIP < 30 cm H2O
• VT 6-8 ml/kg
• PEEP 8-10
• Low FiO2
Avoid auto PEEP!

15. • primary graft dysfunction “24/72hrs”
• Rejection and Infection “24hrs”
Long term:
• Rejection after few months - 1year.
How it can be detected?
10% - 15%
PFT CXR
Bronchoalveolar lavage

16. 5 year
survival
3 year
survival
2 year
survival
49%68%76%
Lung
transplant

17. • Healthy diet and exercise.
• Vaccinations.
• Lung expansion therapy.
• Routine care and health screening.

18. • Since 2003 King Faisal Specialist Hospital and
Research Center has a program for lung
transplantation.
• From 2003-2014 more than 70 lung
transplantation were done ether single,
double or lobe transplant.

20. • lack of organ donors!
• Limited number of donor organs suitable
for transplant.

21. Donate Now It
Won’t Take Your
Time, But If You
Don’t It May
Take Their Lives

22. • UpToDate
• Johns Hopkins medicine library
• vine, S.M. and Angel, L.F. (no date) ‘The patient who has undergone lung
transplantation: Implications for respiratory care introduction indications for lung
transplantation evaluation outcomes management after the Postoperative period
complications following lung transplantation Postoperativ’, .
• Jennifer M. Wilson, MD, FRCPC, John Yee, MD, FRCSC, Robert D. Levy, MD, FRCPC.
Lung transplantation in British Columbia: A breath of fresh air; 2010.
• J. W. Awori Hayang and Jonathan D’Cunha. The surgical technique of bilateral
sequential lung transplantation; 2014.
• Survival statistics from SRTR (Scientific Registry of Transplant Recipients) for Dec
2015
• A Guide to the Care of Lung Transplant Recipients at Brigham and Women’s
Hospital; 2016.
• King Faisal Specialist Hospital and Research Center.
• Saudi Center for Organ Transplantation.