What is the preparation for a lung cancer patient considering a lung transplant?

If a patient with lung cancer is considering lung transplant treatment, he or she should be evaluated and prepared in the following areas.

Tumor-related testing

Tumors should be biopsied or previously removed tissue should be thoroughly examined to rule out more aggressive disease. You will need a chest and abdominal CT, brain MRI, bone scan, and PET-CT for more accurate tumor staging, and should be checked periodically (recommended every 3 months) to monitor for tumor metastases, which will be moved off the lung transplant waiting list if they develop.

Preoperative preparation

Your doctor will prepare you for surgery in detail in the following areas, so please work with him/her to complete them.

1. Breathing exercises and respiratory-related tests

Before surgery, you will need to do breathing exercises, deep breathing, lip reduction exercises, blister blowing, walk test, and ladder climbing test under the guidance of your doctor.

Pulmonary function tests are an important part of the procedure. The relevant items include tests of ventilatory function (including arterial and transcutaneous oxygen saturation measurements), respiratory regulation (including CO2 response and respiratory regulation during sleep), and pulmonary ventilation function (ventilation flow ratio scan). The doctor will also monitor disease activity, do fiberoptic bronchoscopy, and analyze and culture the lavage fluid. In addition, you will need to have other tests such as a drug sensitivity test.

Before the procedure, you will work with your doctor to control the respiratory infection.

2. Cardiovascular system tests

Routine electrocardiogram, cardiac ultrasound, and coronary angiography if necessary. In addition, you will need to have a right heart catheterization, measure pulmonary artery pressure, and observe responsiveness to medications.

3. Diet

Before the procedure, your doctor will intensify systemic support therapy with high-calorie, high-protein, vitamin-rich, easily digestible foods.

Extracorporeal lung support

In addition, to provide adequate pulmonary support while waiting for surgery, extracorporeal lung support techniques, including modified extracorporeal membrane oxygenation (ECMO, or “artificial lung”) and ECMO miniaturization devices, can be used when necessary

ECMO, as a form of extracorporeal life support, provides circulatory support in addition to respiratory support during lung transplantation, allowing for rapid improvement of decompensated cardiac insufficiency and maintaining circulatory stability.

The results of several recent studies have shown that ECMO, after modification, allows for a smooth transition to lung transplantation in most patients with acute respiratory failure, with significantly lower postoperative complication rates, morbidity and mortality rates, and days of hospitalization compared with patients in the same level of severe disease (patients with severe acute respiratory failure or end-stage idiopathic pulmonary hypertension on conventional extracorporeal circulation).

Where does the donor come from?

Since January 1, 2015, China has stopped using organs from death row inmates as a source of transplant donors, and voluntary organ donation after a citizen’s death has become the only channel for organ transplant use. In this context, citizens’ brain-dead and heart-dead donors became the main source of lung transplantation donor lungs.

Organ donation in China is still in its infancy compared to Europe and the United States, and many potential donor lungs lack adequate maintenance, leading to failed donations or are of mediocre quality and cannot meet ideal donor lung standards after acquisition, and are used as marginal donor lungs in clinical applications, putting tremendous pressure on clinical transplantation. As transplant teams continue to improve their skills, physicians will strive to utilize every available donor lung to transplant more patients in need and save more lives.