Dr. James Hardy Performed The First Successful Long Term...

Dr. James Hardy performed the first human lung transplant in 1963, although the patient only lived 18 days.1 The first successful long-term lung transplant was performed in 1983 in Toronto. Recipients of the first lung transplants were plagued by infection, rejection, and most significantly, bronchial anastomotic dehiscence.2 However with advancements in bronchoscopy, ventilation perfusion screening, echocardiography and radiological imaging, there are other post-surgical complications which have been identified as important risks for lung transplant patients. Lung transplantation can take two forms: 1) as a single-lung transplant (to either side via thoracotomy) or 2) as a bilateral-lung transplant (via bilateral thoracotomies or via a†¦show more content†¦While the donor lung is being prepared and removed from its cold ice gauze (a technique to extend the cold preservation time), the pulmonary vessels within the thorax are clamped off. When considering order of re-anastomosis and insertion of the donor lung, bronchial arteries are reattached first, followed by the pulmonary artery, then the pulmonary veins.2 Before the final sutures are tightened, the donor lungs are inflated and aerated. The final steps of the procedure include a bronchoscopy, which examines the airways and detects any unwanted blood or secretions. However, bronchoscopies should be done sparingly as their uses may cause a delayed pneumothorax in a lung transplant patient.3 Post-transplant, patients are monitored very closely in the intensive care unit (ICU) and pharmacological and mechanical management is implemented when necessary. Within the first 24-48 hours after surgery, a patient is ventilated and their Po2 and Pco2 levels are scrutinized. Diuretics may be used in order to avoid any complications from fluid buildup or imbalances that may occur and help with pulmonary recovery.2 Other complications that may occur within the first two days of surgery include: technical complications, graft dysfunction, infections, and rejection. Stenosis of one or more of the anastomoses accounts for 15% the technical complications, which may lead to graft dysfunction.4 Other components of graft dysfunction incorporate pathology from