Talk:Lung transplantation

What about the ribcage?

There is no reference to the ribs in this article.

Wow.

Nice job! When I first looked at it, I thought it had been around for ages! Fredil 01:51, 2 November 2006 (UTC)

References section

I still haven't figured out how to do the references here, so I'll just list them in the order that they were used, and hope that someone else will fix the formatting. There are some cases where multiple sources say pretty much the same thing, which makes it even more confusing.

Aetna InteliHealth http://www.inteihealth.com/IH/ihtIH/WSIHW000/9339/31212.html Accessed on September 29, 2006.

eMedicine from WebMD http://ww.emedicine.com/med/topic2980.htm Accessed on September 29, 2006.

Cleveland Clinic http://www.clevelandclinic.org/health/health-info/docs/2700/2720.asp?index=4491 Accessed on September 29, 2006.

I know that other sources were also used, I just have to relocate them. Thanks in advance! --Kyoko 12:27, 3 November 2006 (UTC)

Also to be mentioned...

Just making a note so I don't forget (but if somebody gets to it before I do, thanks), the fact that during transplantation nerves are severed and aren't reconnected so feelings in the lungs are gone. While an obvious side effect it adds more danger since it's harder for the patient to tell if there is phlegm that needs to be removed from the body, if it's harder to take in air, or if there's an infection settling in the chest. I would say this might not even need a mention but since nerves are cut it is easier for a patient to get sick without realizing it since they don't feel bad or heavy in the chest. I don't have references for this right at the moment or else I'd add it myself. --ImmortalGoddezz 17:10, 4 November 2006 (UTC)

Wow. I didn't read your message, and just added content about this very topic. You might want to reword it or move it to another section. I wasn't sure about where it should go. I'm just very surprised that we seem to have thought the same thing at almost the same time. --Kyoko 17:18, 4 November 2006 (UTC)

Haha, yeah I noticed... strange. I meant to put it in last night, or at least make a mention of it.. --ImmortalGoddezz 01:24, 5 November 2006 (UTC)

should there be a detailed section on drug regimen?

Should there be a more detailed section on the immunosuppressive drug regimen that lung transplant patients must take? I don't have experience with this personally, but from what I've read, such patients are commonly put on a regimen of three different medications. I don't know how that compares with people who have had other organs transplanted. Any thoughts on this? Thanks, --Kyoko 00:28, 5 November 2006 (UTC)

My opinion on this: No, it should not be. Not all transplant patients are put on the same medications for different reasons. (ex. I am on prednisone, cellcept, and prograf whereas I was on ciclosporin (found out I was allergic to it), and Imuran. So not everybody is the same and cellcept (which a number of lung transplant patients are on) is actually as far as I know used for the most part on kidney transplant patients. So everybody is different. I'd leave it as general 'immunosuppressive medications' unless you want to say a 'steroid therapy coupled with an immunosupprssent specific drug' since steroids are also used to suppress the immune system. But just saying steroid therapy with something like a calcineurin inhibiter gets you into describing drug details.. since not all immunosuppressants are calcineurin inhibiters... so it gets confusing. --ImmortalGoddezz 01:24, 5 November 2006 (UTC)

OK, I understand completely about people reacting differently to different medications — I'm allergic to penicillin, and then there was that whole thing in September that I trust you've heard about. The current text is the following:

In order to prevent transplant rejection and subsequent damage to the new lung(s), patients must take a regimen of immunosuppressive drugs. Patients will normally have to take a combination of these medicines in order to combat the risk of rejection. This is a lifelong commitment, and must be strictly adhered to. As episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time.

As far as I know, this is both accurate and general enough to apply to most if not all transplant cases. Thanks for your reply. --Kyoko 03:42, 5 November 2006 (UTC)

I added some more details. --WS 23:57, 6 November 2006 (UTC)

I added some more updated details and evidence, also under a few other subtitles 86.17.1.198 (talk) 23:30, 27 January 2024 (UTC)

what are "excess fluids" exactly?

Hello, I wikilinked the term "excess fluids" (post-transplant) to Pleural effusion, but I was wondering if there is a more specific term that might be more appropriate. I've found articles like Hemothorax, Hydrothorax, and Chylothorax. I don't know enough about the subject to tell what the fluids are, but I would guess that it would be a combination of blood, lymphatic fluid, and serous fluid. Is just the pleural effusion link OK? Thanks. --Kyoko 06:38, 5 November 2006 (UTC)

I think it would be mostly serous fluid, but linking to pleural effusion covers it all nicely. --WS 22:04, 6 November 2006 (UTC)

Let's see... when I think about it, the blood vessels to the lung(s) would have been tied off, and any blood would probably have been suctioned off during the surgery, so yeah, that makes sense. --Kyoko 23:26, 6 November 2006 (UTC)

questions on history, lobar transplants, surgical procedure

Hello, I have a number of questions and comments regarding lung transplants, and these are all geared towards improving the article. Please forgive me if the questions seem naive.

1. The section on the history of lung transplants greatly needs to be expanded. I've done what I can, in my own non-specialist way, but it needs more.

2. I am extremely fuzzy about the procedure of lobar transplants. I understand that the left lung has 2 lobes and the right lung has 3, and that the lower lobes are used in donation. What I don't get is the procedure itself. Are the individual lobes collapsed (if that is possible) and the relevant blood vessels tied off, similarly to the single/double lung procedures?

3. The Merck Manual 18th edition talks about chronic rejection taking the "form of obliterative bronchiolitis, or less commonly, atheroschlerosis". Is this the same as bronchiolitis obliterans? I understand that as a result of an immune response in this case, tissue is formed that can no longer perform normal lung functions (or perform poorly). So once again, are obliterative bronchiolitis and bronchiolitis obliterans the same thing? The bronchiolitis might be worth mentioning in the article.

4. Probably the most important question for my understanding, if not for the article itself: if the patient's lungs are diseased enough to require a transplant, then how exactly do they maintain adequate oxygenation of the patient while one or both lungs are removed? The section on double tx says that 10-20% of patients are hooked up to a heart-lung machine, which makes sense. This doesn't explain what happens to the other patients.

I know that the oxygen concentration of what the patient breathes can be increased, and that for normal people, they can survive fine on one healthy lung, but this still doesn't explain (to me anyway) what happens to a patient with poor lung function who is having at least one lung temporarily removed. Is it normally enough to supply a 100% O₂/anesthesia mix during the surgery, or are such patients also put on a heart-lung machine or similar device?

Thanks for any answers, and I'm sorry if the questions sound odd or naive. --Kyoko 03:01, 12 November 2006 (UTC)

Can't really answer the other questions without looking them up first but as for your last question you state "they can survive fine on one healthy lung." When in actuality people who are going in for double lung transplant usually are not depending on one healthy lung, both lungs are equally damaged or one is more damaged than the other one. Sometimes one lung is so damaged that it's practically not in use anymore perhaps except a lobe. Which is why during a double lung transplant they remove the severely damaged lung first and then the one with the better functions last. Pre-transplant patients usually aren't considered for transplantation until their FEV1 hits the 30% range, if not lower, and even then it's more of a quality of life factor. The thing is some transplant patients might not need oxygenation because their lungs are functioning adequately enough to oxygenate the body but perhaps at not the level the body needs to preform at it's peak level. The 30% level (roughly) is when patients feel that they cannot do strenuous activities with adequate oxygenation but can remain stationary and perhaps have a higher O₂ level. And in reality a (healthy) person's O₂ level is usually in the mid-nineties.

I feel that the explanation is a bit loose. What I mean to say is that a person who is undergoing transplant evaluation cannot usually say walk up the stairs without getting severely winded and out of breath, but while stationary their oxygen levels increase because they're not doing anything. This is where the quality of life comes into play when deciding for a transplant, so the eval isn't just based on what your PFT numbers are, if you're getting good PFT numbers while sitting down and then go for a 60 second walk and your pft's dip dramatically you're not going to be doing much besides sitting down and without exercise your pft's continue to go down, etc. If the lung that they replace last is clear enough to support you during transplantation then I don't think the use of a heart-lung machine is needed, I'm pretty sure they can figure out if you'll need a heart-lung machine by the Ventilation/perfusion scan test, though I'm not 100% sure. Hope this answers the question somewhat. --ImmortalGoddezz 03:13, 13 November 2006 (UTC)

Hmm, yes, I understand that with lung disease both lungs are normally affected, sorry if my choice of words wasn't sufficiently clear. You raise a good point about resting O₂ sats on RA, one that I should have thought of when typing out my original set of questions.

I found the answer to the bronchiolitis obliterans question, and yes, they are indeed the same. I might add this to the article a little later.

I also have numbers regarding post-tx survival rates up to 10 years from surgery, but they're a little dated (1992-2002). I'll try to find newer statistics and add them later as well. It's just been an eventful week, so I'm slowly getting back into the swing of things. --Kyoko 03:48, 13 November 2006 (UTC)

Some corrections to my last message... make that "with lung disease both lungs are normally affected (with the exception of cancer)". Also, the statistics I have are a breakdown of cause of death following a transplant. I did find an old list of post-tx survival rates up to 10 years after surgery, and I will try to track down a new one. Thanks again. --Kyoko 13:19, 13 November 2006 (UTC)

I just went to the ISHLT website, and I just can't find an updated list of post-tx survival rates. Do you think that it's worth putting the older, more comprehensive numbers, or just stick to the newer, less-comprehensive but more currently relevant numbers from the Merck Manual? --Kyoko 13:45, 13 November 2006 (UTC)

I was editing cardiothoracic surgery and there was some lung transplantation history which is more appropriate on this page

Animal experimentation by various pioneers, including Vladimir Demikhov and Dominique Metras, in 1940s and 1950s demonstrated that the procedure is feasible technically. Hardy performed the first human lung transplantation in 1963. Following a left lung transplantation, the patient survived for 18 days. From 1963-1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing.

I removed the above text, but placed it here rather than deleting it. Dlodge 20:29, 17 December 2006 (UTC)

Thanks, Dlodge, for finding that text. I've tried to incorporate it into the history section, but there are some issues that remain unclear. For reference, here is what I have in the article:

The history of organ transplants began with several attempts that were unsuccessful due to transplant rejection. Animal experimentation by various pioneers, including Vladimir Demikhov and Dominique Metras, during the 1940s and 1950s, demonstrated that the procedure is feasible technically. Hardy performed the first human lung transplant in 1963. Following a left lung transplantation, the patient survived for 18 days. From 1963-1978, multiple attempts at lung transplantation failed because of rejection and problems with anastomotic bronchial healing. It was only after the invention of the heart-lung machine, coupled with the development of immunosuppressive drugs such as ciclosporin, that organs such as the lungs could be transplanted with a reasonable chance of patient recovery.

If you look at the text in edit mode, you can see the hidden comments. In order to save you that trouble, I'll list here my questions regarding this block of text:

1. Demikhov and Metras demonstrated that lung transplantation in particular was technically feasible, or thoracic surgery in general?
2. "Hardy performed the first human lung transplant..." The James Hardy referred to on the organ transplant page is an American football player who was born in 1985. Would you happen to know who the correct Hardy is?

Thanks again for finding this information! --Kyoko 19:55, 18 December 2006 (UTC)

I'm on vacation, when I said I probably wouldn't be online, and here I am back on Wikipedia. Pathetic. Anyway, I've learned the answers to my questions, but the source for the content on James Hardy needs to be reformatted. My source was http://transplant.emory.edu/lung/intro/history.cfm . If anyone could do this, that would be great! I don't know when or if I'll be online again for the next month, so we'll see. Thanks again! --Kyoko 07:43, 22 December 2006 (UTC)

worth mentioning the process of preparing donor lungs?

Hi there, do you think it would be worth mentioning the process of preparing donor lungs, i.e. their removal, inspection, prostacyclin wash, etc.? --Kyoko 06:53, 16 November 2006 (UTC)

Of course, that would be very interesting. --WS 23:05, 17 December 2006 (UTC)

I'd like to add this info, but I'm away from my sources right now and will be far away on wikibreak very soon. Thanks for the input! --Kyoko 19:59, 18 December 2006 (UTC)

2 things: lists vs. prose, and possible WP:AID?

Hello, in one of the other pages that I've edited, I encountered the viewpoint that things should generally be in prose rather in lists, particularly if the article is under consideration for Good Article or Featured Article status.

As you know, the lung tx article currently has a lot of lists. I personally feel that keeping things in lists makes it easier for a reader to process a large amount of information, as in the list of requirements for potential recipients. There are also some things that I feel must be in a list or graph form, such as the list of qualifying conditions. I would appreciate some opinions on this.

Another thing: I'm considering submitting this to the Article Improvement Drive, in the hope that a wider audience might be able to fill in the gaps. I myself tend to hop from subject to subject here on Wikipedia, but I hope to get back into building this article again. --Kyoko 21:50, 11 April 2007 (UTC)

Contraindication: Psychiatric Conditions?

Sometimes things get into the literature for no real justified reason. By what reason are the mentally ill to be refused life saving treatment. I noticed that drug therapy for hepatitis C also has this contraindication for the mentally ill, but the reason given for that is the drug therapy itself sometimes causes CNS symptoms, but even that is shaky. I am not trying to editorialize, I just question the reasoning, what is it based on?

71.114.181.145 (talk) —Preceding comment was added at 20:22, 8 March 2008 (UTC)

In the case of hepatitis C, interferon treatment is known to frequently cause severe depression, which often affects compliance with the treatment regimen (and can contribute to the risk of suicide). That said, sometimes the risk needs to be taken. As to lung transplants, I have no idea. 203.45.65.153 (talk) 15:55, 30 December 2010 (UTC)

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