The Role of Spirometry After a Lung Transplantation

The Role of Spirometry After a Lung Transplantation

Lung transplantation is done by removing a diseased or failing lung and replacing it with a healthy human lung from either a living - or in some cases recently deceased - donor.

If the patient has an advanced lung disease that is unresponsive to other forms of treatment, and the life expectancy of the patient is 2 to 3 years without transplantation, lung transplantation will be recommended. Conditions like COPD, cystic fibrosis, pulmonary hypertension, and idiopathic pulmonary fibrosis can be treated with a lung transplant. 

Lung transplantation recovery

The recovery process after a lung transplant takes at least 3 to 6 months and the patients are susceptible to infections or rejection. For the first 1 to 7 days after the surgery, the patients remain in the intensive care unit. In this period, they will be connected to a ventilator to help them breathe and may receive an epidural for pain relief.

The patient will be monitored by way of regular lung x-rays and lung biopsies to ensure that the body is accepting the new organ. Once the condition of the patient and the new organ becomes stable, they will be moved to a high dependency ward and will stay there for 1 to 2 weeks.

Follow-up after the surgery

Spirometry is seen as the primary tool for the evaluation of lung function in recovering lung transplant patients. It is crucial in detecting the various phenotypes of chronic lung allograft dysfunction (CLAD), including restrictive allograft syndrome (RAS) and bronchiolitis obliterans syndrome (BOS). 

As techniques used in operations improve, outcomes also improve but to ensure improvement of long-term results, early intervention is key. The patient probably will be discharged 2 to 3 weeks after the surgery but will be asked to stay near the transplant center for a month to be able to have regular check-ups. They will need to visit the center weekly for the second month. After that, they will have a blood test every 6 weeks and will be seen at the center for monitoring every 3 months.

The only way for an early intervention to be possible is through proper and diligent follow-up. But, due to the high prevalence of infectious diseases, hospital visits can be risky. This is where home spirometry comes into the picture. A research done on 367 lung transplant patients found that they had an average of 10.6 spirometry tests in their first year after the transplant, suggesting that the testing was frequent. 5

A pilot study shows that home spirometry monitoring is feasible and reliable for lung transplant recipients. 6 Another study done on the subject showed that FVC can be a measurement used to get further perspective on the recovery process of the patients. 7

With home spirometers, patients can measure their lung values in the safety and comfort of their homes, track the data themselves for peace of mind, and even share it with their healthcare team when needed.

 

Sources

  1. "Lung transplant", National Health Service, 2019.
  2. "Lung transplant", Mayo Clinic, 2022.
  3. "Lung transplant", John Hopkins Medicine.
  4. A spirometric journey following lung transplantation”, Journal of the Asian Pacific Society of Respiralogy Case Reports, 2014.
  5. Lung Function Monitoring After Lung Transplantation and Allogeneic Hematopoietic Stem Cell Transplantation”, Clinical Therapeutics, 2022.
  6. "Using Home Spirometry for Follow up of Lung Transplant Recipients: “A Pilot Study", Journal of Respiratory Diseases, Thoracic Surgery, Intensive Care and Tuberculosis, 2013.
  7. "Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes", Transplantation Journal, 2020. 

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