The recipient’s lungs are broken, sticking tightly, the doctor takes half a day to remove from the chest. Meanwhile, the donor lungs are removed, carefully preserved, pending transplant.
Deputy Professor Nguyen Huu wished, head of the Department of Cardiovascular and Thoracic surgery, Viet Duc Hospital, said lung transplantation technique is complicated. The preparation of the cesarean and graft is also difficult, because the lungs are infested with bacteria in both the given and the recipient.
People for the lungs are mainly brain-dead patients, have undergone process breathing, anesthesia, trauma… Should infect many respiratory bacteria.
The most common recipient of chronic lung disease is that the lungs are often infected, dirty, filled with pus, stick to chest as concrete. The doctor takes hours to unstick. At 2-3, long it takes six hours to get the lungs damaged out of the patient’s chest. When removing sticky also be very careful, if the lungs are bleeding will not be possible. This is also one of the causes of major failures for a lung transplant surgery.
“Little or much, the lungs of the person and the recipient are infected, requiring the preparation and lung transplantation is complicated”, the doctor says.
Technically, lung transplantation surgery is very troublesome, many more, requiring the number of doctors to join the east, divide many and need to coordinate in sync with each other. The process of obtaining and preserving the lungs is also harder than other organs in the dead brain.
Principle of organ transplant, when the crew an open-chest surgery gives and reviews good lungs, can transfer graft; Then, the two were allowed to open the recipient’s chest surgery.
“So when the lungs get out of the donor chest must be properly preserved while awaiting transplant on the recipient’s chest”, the doctor wishes to explain. In Vietnam, the first CA to transplant is sticky so the total transplant time takes 14 hours. Fifth graft, the latest, only takes more than 6 hours due to the lungs not sticking.
With a constitutional lung, the process of taking and cutting to protect the lungs is difficult. When taken out of donor breasts, the lungs still have to bulge like a ball. If the lungs are not grafted. The lungs removed, must be washed with separate solution, it is necessary to use stainless steel pots to pump washing. Then the lungs are stored in a temperature of 8-10 degrees Celsius.
With recipients, depending on the pathological condition, someone must transplant part of the lungs, someone transplant the lungs. Therefore the physician must divide the donor-equivalent volume to transplant for the recipient, not exceeding 30% spread. This is a stitch that requires precise meticulous calculations to ensure compatible lung transplantation. Source of transplantation must also meet the conditions of immunity and many other harmony indicators.
The process of transplant into the recipient requires multiple sutures, from preservation, sterile, transporting… Must synchronize. Procedure of anesthesia, placing ECMO support for patients during lung transplantation must be carefully calculated. Only minor flaws in one stitch are non-lung transplantation.
“A difficult heart transplant is hardly even five times, because the complexity, many, many surgical cycles”, the doctor says.
Viet Duc Hospital has now made five lung transplantation, both from the source of the donor dead brain. Before surgical transplant, physicians must measure the size of the lungs to match between the recipient and the given person. In 5 CA, 4 CA Doctors have to cut the lungs.
Often after transplantation, the lungs are broken up. If the doctor closes the chest, the lungs will be pinched and stopped. Therefore, after the transplant, patients do not close the chest immediately but are covered with sterile tools, 2-3 days after the lungs will shrink to close the chest.
Special Postoperative care Very hard. Pulmonary high risk of infection, when graft does not have a plant nerve, does not have a cough reflex, like a normal person. Therefore, the doctor must absorb daily epidemic, airway cleansing, early-morning therapy to restore respiratory muscles.
The first few days after the transplant, the lungs are edematous, the patient is intervened with ECMO (external oxygen) system, taking many antibiotics. The patient recovers very slowly, not as fast as other organ transplantation.
A lung transplant patient at Viet Duc Hospital has to undergo postoperative periods for 10 months to be able to discharge. After transplantation, patients experience a wide range of lung change problems such as a soft graft, pulmonary fibrosis, and the appearance of particles of inflammation… Patients are treated and cared for very long, blessed are healthy.
According to the doctor, not all patients can transplant the lungs. Patients who are contraindicated for lung transplantation such as an extrapulmonary infection, unregulated pulmonary infection, cancer, multiple organ failure, coagulation disorders, spinal malformations, BMI on 35, psychosis, are smoking, alcoholism…
The world records more than 4,000 lung transplantation. In which Europe has paired almost 2,000 CA, the U.S. also nearly 2,000 ca. In Asia, China, Korea, Taiwan, Japan has been successful in lung transplant for patients. Vietnam has made 5 shifts.
The doctor estimates the success of the lung transplant to 85-90%, however the patient’s ability to live long-term is only 50% compared to heart transplant. 50% of lung transplant patients live over 5 years, this figure in heart transplant is more than 10 years. The cost of lung transplant in Vietnam is about 2 billion VND, while the cost of foreign countries is 10 times.
“Patient 91”-the heaviest Covid-19 today, has been assigned by the Ministry of Health to the lung transplant. However patients suffering from coagulation disorders, ECMO intervention for almost a month and a half, the lungs coagulates more than 80%, suffering from “Hurricane Cytokine” syndrome (excessive overreaction immune system)… The Ministry of Health specifies clinical stable medical treatment while finding suitable lung sources from the dead brain donor.