Saturday, July 25, 2020


    I  wrote in my past blog about how the lung transplant is not like fixing hernia or taking a mole out. It is not a 'cure' by any stretch of imagination when we talk about Lung transplant.But there is more to lung transplant than just getting a match. The kidney or renal transplant is done much more commonly as the kidneys can be obtained even from cadaver or LIVE Donner. But for Lung transplant we need a match only from someone who is dying- but not dead. So who will get it is pure luck. In past we used to do both lungs  and for last more than 10 years or so we are doing single lung transplant . This helps in number of ways. Instead of one patient getting transplant, we have 2 patients getting it . In case of rejection, patient still has one of his own lung.But there are many problems  and issues.Weight or ideal weight is important . One can not be too heavy or too skinny .
    That brings me to the story of my patient for today. I have known this patient for more than 5 years . He was 60 years old male who was heavy and had shortness of breath. He was a smoker and had quit. But the smoking had done it's damage  and he had COPD - emphysema . He had shortness or breath and lots of cough and sputum . He was seen by me  and he was started on medications  and he did better. He continued to work . I had told him that part of the problem is his obesity. The shortness of breath can happen due to obesity and also deconditioning which happens due to lack of exercise. The part of the reduction of pulmonary reserve could be due to big belly and obesity. So weight loss was essential. But he did not loose much . Over period of time he got worse  and then he needed to be on oxygen . He continued to work as he had desk job and he could do it. I did new breathing and he was worse and so I did ask to to consider lung transplant evaluation. He agreed  and he did go and was evaluated by the Transplant physician. They told him that he was a good candidate , but it may take another 6 months or so for him to be perfect candidate or to be on active list . But that can happen only if he would loose 20- 25 lbs of weight, That amount of weight loss would not bring his weight to ideal body weight but that was essential per the transplant MD. The time passed  and he continued to get worse  and the shortness of breath was worse  and his need for oxygen went up . Instead of 2 L he needed 5 L oxygen . He did go back to the transplant group of physicians He had not lost a single LB but instead had gained . So then he did not go to them for 6 months. They told him that he has to loose some weight and they will see him again. I was doing follow up and he was admitted couple of times . Then I did routine yearly chest x- ray and that showed a spot on the lung . The suspicion for cancer was high and so I did PET SCAN  and that was positive  and so he most likely had cancer of the lung , He was not a candidate for any surgical intervention. I did needle biopsy and so I send him for radiation  and then oncologist . 
     The transplant was out of question and he has not lost any weight  and has continued to gain some with not much physical activity. 
   The question that bothers me is that if he has a lung transplant what would have happened. If he had transplanted the lung that developed the cancer , he would not have cancer now  and if it was the other lung -- then the transplant would have been wasted ???

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