Tommy Johnson

The First Successful Human Lung Transplant Without Anti-Rejection Drugs

Immunology, Lung Transplant, Medicine, Pharmacology, Surgery

The First Successful Human Lung Transplant Without Anti-Rejection Drugs

On June 11, 1963, a man with advanced cancer was given his life back through lung transplant.

Lung transplantation has advanced significantly since then, with steadily improving perioperative and long-term survival rates. Unfortunately, chronic rejection remains a significant barrier to quality of life and longevity after transplantation.

History

Recently, lung transplantation was not widely considered to be an appropriate treatment option for most end-stage pulmonary patients. They were often disqualified due to poor organ compatibility issues or preexisting conditions that might worsen posttransplant; such factors include severe illness, high blood pressure, poor renal function or coexisting diseases like peptic ulcer disease and diabetes.

In the 1980s, however, pulmonary surgeons and their teams developed techniques that made lung transplantation possible for more people. Over time they devised an effective plan for minimizing early rejection; this strategy is still utilized today and relies upon reducing donor ischemia time and restricting exposure of oxygen-deprived lungs to the airway system.

On March 9, 1981, Stanford cardiothoracic surgeon Dr. Norman Shumway and his team successfully carried out the world’s inaugural heart-lung transplant for 45-year-old newspaper executive Mary Gohlke suffering from primary pulmonary hypertension. Not only was this operation considered medical history-making but it also offered hope to millions living with end-stage lung diseases without an effective treatment solution.

At that time, the only available drugs to prevent organ rejection were powerful enough to suppress surgical healing – something the transplant team sought to avoid because this increased the risk of airway anastomotic dehiscence, which often occurred among those receiving multiple organs concurrently and could sometimes prove fatal [1].

Washington University in St. Louis researchers pioneered tolerance-inducing blood transfusions to introduce cells from donors into recipients’ immune systems and help their bodies recognize them without rejecting. Their work resulted in the development of cyclosporin A, which proved highly successful during animal experiments before finally receiving approval by the U.S. Food and Drug Administration for use by humans – although by that point Gohlke had already been diagnosed and had arrived at Stanford.

Yet until 2009 there had been no long-term survivors of lung transplantation. The initial case involved IPF patients receiving bilateral sequential lung transplantation in 2004 before succumbing to disseminated intravascular coagulopathy and multiorgan failure on their 11th postoperative day, leading to a poor outcome and very late death.

Preparation

The transplant team will interview and conduct tests to ascertain if lung transplantation is right for you. You may meet with multiple specialists such as an ENT doctor and oncologist (cancer specialist). Psychological testing will also take place to ascertain your ability to cope with surgery, rejection, loss of old lung tissue and medications’ side effects.

Once your transplant team determines that you qualify, they will register and place you on a waiting list at a hospital that performs lung transplants. Regular check-in visits at their center will take place to make sure that you remain eligible for transplant.

See also  Development of New Cancer Treatments

As soon as a donor lung becomes available, you will be informed and be asked to go the hospital for surgery. While waiting, your lungs will be prepared for surgery by washing and disinfecting. For your safety during this process, general anesthesia will be administered so as to minimize pain during this procedure.

After your surgeon has finished operating, a tube will be connected from your throat to a ventilator that will assist with breathing. Meanwhile, medications will be given through a vein in order to manage pain and prevent rejection of the new lung transplanted into you. As your immune system treats these transplants as foreign bodies similar to how it would a splinter in a finger would react; hence, anti-rejection drugs must be taken to ensure their safe integration into your system.

Your transplant team will carefully observe you in the intensive care unit, checking to see how well your new lungs are functioning and monitoring for signs of infection or altering dosages of immunosuppressants – drugs which help keep the new organs from being recognized by your body as foreign bodies.

As soon as your transplant surgery has taken place, you’ll be taken to the posttransplant unit where you will learn how to take care of yourself and your new lungs. Working with respiratory therapists and physical therapists to strengthen so you can use your new lungs more efficiently; taking blood samples to determine kidney, liver and heart functioning efficiently; taking blood samples for analysis purposes if necessary – once all these tasks have been accomplished successfully your doctors will remove tubes in both throat and stomach tubes so you may leave hospital.

Surgery

Transplant surgery itself is an intricate process. While under general anesthesia, a tube will be guided down your throat into your windpipe so a surgical team can extract your diseased lung and connect its blood vessels to those of its new counterpart. They’ll also strive to avoid rejection as your body cannot produce its own antirejection medicines during this period; as such, strong drugs will need to be administered. While these may have side effects of their own, such measures will hopefully reduce rejection significantly.

After surgery, you will be connected to a mechanical ventilator to assist your breathing. Once your condition has improved, this device will be removed; however, you may require hospital stay of one week or longer; depending on how well medications respond and your rate of healing.

As part of your lung transplantation procedure, you must agree to take life-long immunosuppressant medications to keep the new lung(s) healthy. While immunosuppressants will reduce your immune system and potentially increase your risk of infections, your doctor will create an individual treatment plan tailored specifically to you and your preferences. Common medications include basiliximab (Simulect), nucleotide blocking agents such as mycophenolate mofetil and azathioprine as well as tacrolimus (Astagraf XL Envarsus XR Prograf) and cyclosporine (Gengraf Neoral Sandimmune).

See also  Development of CRISPR Gene-Editing Technology

Before getting a lung transplant, your doctor will assess whether you can mentally adapt to major lifestyle changes such as moving or altering your diet, taking medications as prescribed, and receiving care. Lung transplantation may not be suitable for everyone; you must meet specific criteria before being accepted onto the United Network for Organ Sharing’s waiting list; factors influencing this timeline could include age, blood type and illness severity.

Postoperative Care

After surgery, patients are taken directly to an intensive care unit for monitoring and treatment of complications. Most often, pulmonary vascular resistance and respiratory function recover within days posttransplant. Some may require further hospital stays due to acute rejection or graft dysfunction issues; infection and other medical conditions may also impair lung functioning posttransplant.

Primary graft failure or allograft dysfunction is the leading cause of early mortality after lung transplantation, followed by significant surgical complications, perioperative bleeding complications, pulmonary vein anastamotic complications and ventilator-induced barotrauma.

On March 9, 1981 at Stanford Medical Center in California, a pioneering lung transplant operation took place for Mary Gohlke (45), suffering from Idiopathic Pulmonary Fibrosis (IPF) who received her new lungs and lived five years thereafter.

Since that time, several lung transplant centers have emerged worldwide; however, in 2009 the first successful lung transplant in Turkey occurred at Sureyyapasa Hospital in Istanbul.

Turkish transplant centers now operate four lung transplant centers – two in Istanbul and one in Ankara – which use United Network for Organ Sharing (UNOS) as their waiting list system. Your wait may depend on several factors including blood type, age and the reason behind needing a lung transplant; depending on these variables it could take years before an organ becomes available to be transplanted into you.

Once on the waiting list, you will be notified as soon as a lung transplant organ becomes available. Our lung transplant team will discuss their procedure thoroughly with you before beginning with your transplant procedure.

An intensive lung transplant procedure, however, is possible provided you select an experienced transplant center and follow your physician’s advice. With proper planning, it may result in healthy, functional lungs.

Preparing mentally and physically for surgery is of utmost importance. A positive attitude and compliance with all instructions from your transplant doctor are both key to the process of transplanting organs successfully. Your transplant physician will also inform you which medications to take to prevent rejection after the operation and ensure a strong immune system postoperatively.

Leave a Comment