Lung and heart-lung transplantation

[Julene]

Lung transplantation is the surgical removal of a healthy lung or part of a lung from a living person and then its transfer into someone whose lungs no longer function. Heart-lung transplantation is the surgical removal of both the heart and lungs from a recently deceased person and then their transfer into someone whose heart and lungs no longer function.
(See also Overview of Transplantation and Heart Transplantation.)
Lung transplantation is done for people whose lungs no longer function. Most recipients are people who have one of the following disorders:

Severe chronic obstructive pulmonary disease (COPD)
Idiopathic pulmonary fibrosis
Cystic fibrosis
Alpha-1 antitrypsin deficiency
Primary pulmonary hypertension

One or both lungs can be transplanted. When a lung disorder has also damaged the heart, one or both lungs and a heart may be transplanted at the same time. Single and double lung procedures are about equally common and are at least 8 times more common than heart-lung transplantation.
Because preserving a lung for transplantation is difficult, lung transplantation must be done as soon as possible after a lung has been obtained.
The percentage of people who survive after receiving a lung transplant is

At 1 year: Over 80%
At 5 years: Over 50%

A heart-lung transplant is done for

Certain heart abnormalities that are present at birth (for example, Eisenmenger syndrome)
A severe lung disorder that has also caused heart damage

[Kai]

Lung or heart-lung transplantation is an option for patients who have respiratory insufficiency or failure and who remain at risk of death despite optimal medical treatment.
The most common indications for lung transplantation are

COPD
Idiopathic pulmonary fibrosis
Cystic fibrosis
Alpha-1 antitrypsin deficiency
Primary pulmonary hypertension

Less common indications include other interstitial lung disorders (eg, sarcoidosis), bronchiectasis, and congenital heart disease.
Single and double lung procedures are equally appropriate for most lung disorders without cardiac involvement; the exception is chronic diffuse infection (eg, bronchiectasis), for which double lung transplantation is best.
Indications for heart-lung transplantation are

Eisenmenger syndrome
Any lung disorder with severe ventricular dysfunction likely to be irreversible

Cor pulmonale often reverses after lung transplantation alone and is therefore rarely an indication for heart-lung transplantation; however, sometimes a heart-lung transplantation is necessary.
Relative contraindications include age (single lung recipients must be lt; 65; double lung recipients, lt; 60; and heart-lung recipients, lt; 55), current cigarette smoking, previous thoracic surgery, and, for some cystic fibrosis patients and at some medical centers, lung infection with resistant strains of Burkholderia cepacia, which greatly increases mortality risk.
Single and double lung procedures are about equally common and are at least 8 times more common than heart-lung transplantation.