Highly sophisticated and extraordinary therapies, such as lung transplantation, are performed at a great cost to society. Presently, active research is being conducted on enhancing the patient's quality of life following lung transplantation. Several studies have reported a significant improvement in different quality-of-life domains, tested pretransplant and posttransplant. Other studies comparing candidates and lung transplant recipients have demonstrated significant improvements in energy levels, physical functioning, mobility, and symptoms such as dyspnea and anxiety. The recipients have expressed greater satisfaction with their lives and their health following lung transplantation.
Attempts to compute the costs of lung transplantation to general society and to determine the cost effectiveness of this therapy have been made. Cost evaluations should take into account both the actual cost and the improved quality of life provided by this therapy compared to standard care. The cost is expressed in units of QALY (quality-adjusted life-year), which reflects the real or anticipated survival time and health-related quality of life.
In 1995, the University of Washington Medical Center estimated that lung transplantation costs $176,817 per QALY compared with traditional therapy. [4] A study of 3000 Medicare patients who received lung transplantations between 2005-2011 found that the average cost of lung transplantation was $135,622. However, high-volume transplant centers (35 or more lung transplantations annually) had a mean transplantation cost of $131,352. In addition, median length of stay in the intensive care unit fell significantly with increasing lung transplantation volume, from 14 days in low-volume centers to 11 days in intermediate centers and 10 days in high-volume centers. [5]
Additionally, after adjusting for recipient health risk, low-volume centers had an 11.66% greater transplant admission cost (P = 0.040), a 41% greater risk for in-hospital mortality (P = 0.015), and a 14% greater risk for early hospital readmission (P = 0.033) compared with high-volume centers. There was no significant difference in transplant cost, in-hospital mortality, or early hospital readmission between intermediate- and high-volume centers. [5]
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This chest radiograph performed 24 hours following right unilateral lung transplantation is within normal limits.
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Seventy-two hours following lung transplantation, this patient developed dyspnea and hypoxemia. The bronchoscopy and bronchoalveolar lavage revealed no evidence of bacterial infection. The likely cause of this deterioration is reperfusion/reimplantation response.
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A 19-year-old woman had living donor transplantation. She developed pulmonary artery stenosis several months later. This was treated with a pulmonary artery stent. Courtesy of A. Szabo, RN.
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This patient developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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Lateral chest radiograph on a patient who developed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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The CT scan of the chest of a patient with confirmed anterior mediastinal abscess 1 year following bilateral sequential lung transplantation. Courtesy of A. Szabo, RN.
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A 34-year-old man developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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Lateral radiograph of a 34-year-old man who developed branchio-otorenal (BOR) syndrome 3 years following sequential bilateral lung transplant (BLT). The chest radiograph shows characteristic findings of hyperinflation and hyperlucent lung fields. Courtesy of A. Szabo, RN.
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The high-resolution CT scan showing findings of branchio-otorenal (BOR) syndrome following bilateral lung transplantation (BLT).
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Bronchopleural fistula following right pneumonectomy and left single-lung transplantation (SLT).
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Severe acute rejection within 10 days of lung transplantation (lower magnification). The typical histological findings are perivascular lymphocytic infiltrates. Courtesy of Zhaolin Xu, MD.
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Severe acute rejection within 10 days of lung transplantation (high power). Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the low-power field, which is indicating acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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The transbronchial biopsy shows perivascular aggregates of lymphocytes in the high-power field, which indicates acute rejection in this patient 60 days after the lung transplant. This is grade II rejection. Courtesy of Zhaolin Xu, MD.
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Bronchial anastomosis. Posterior wall closure is performed with a continuous suture.
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Right atrial anastomosis. Continuous anastomosis with the common pulmonary vein joined to the atrium.
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Completed atrial anastomosis.
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Donor lung showing hilar surface.
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The clamps are exposing the donor vein.
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Donor bronchus, artery to the right and vein to the left.
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Right donor bronchus.
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A close-up shot of the donor vein.
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Bilateral lung transplantation to treat cystic fibrosis in a 23-year-old woman. Anteroposterior (AP) chest radiograph shows mild edema in the right perihilar region soon after surgery; this finding is consistent with an implantation response.
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Anteroposterior (AP) chest radiograph obtained the following day shows increased edema.
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Bilateral lung transplants in 23-year-old woman who developed infection at the bronchial anastomoses. CT scan shows right bronchial stenosis (arrow).
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CT image shows left bronchial stenosis (arrow).
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Posteroanterior (PA) chest radiograph in a 23-year-old woman who underwent bilateral lung transplantation because of cystic fibrosis. Image shows left upper-lobe collapse. Bilateral bronchial stents are in place.
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Lateral radiograph shows left upper-lobe collapse. Arrow points to a bronchial stent. Bronchoscopy showed that scar tissue obliterated the orifice to the left upper-lobe bronchus.
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CT image in a 61-year-old-woman with a single-lung transplant for emphysema with Aspergillus infection. Image shows an ill-defined nodule in the right upper lobe with a surrounding halo of ground-glass opacity (arrow), a finding virtually diagnostic of Aspergillus infection in the correct clinical setting.
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Aspergillus infection 61-year-old man with a left lung transplant because of idiopathic pulmonary fibrosis. Frontal chest radiograph shows a normal left (transplant) lung and lower-lobe consolidation in the right (native) lung.
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CT of patient shows patchy areas of consolidation in the right lower lobe and a clear left lung. Biopsy showed Aspergillus infection.
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Cytomegaloviral (CMV) infection in a 52-year-old man with a right lung transplant because of emphysema. Frontal chest radiograph shows right lower-lobe and left mid-lung consolidation and a small right pleural effusion. Note that the less-compliant transplant lung pulls the mediastinum to the right.
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CT of patient with cytomegaloviral (CMV) pneumonia shows patchy consolidation, greater on the right (transplant lung) than on the left, and a right pleural effusion.
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Chest radiograph in bilateral lung transplant recipient showing bilateral pneumothoraces (arrows).
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CT shows pneumothorax in common pleural space (arrow).
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Lung carcinoma in lung transplant recipient. PA chest radiograph shows a spiculated nodule in the lower lobe of the native right lung.
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Primary lung carcinoma in lung transplant recipient. CT scan of patient with previous radiograph shows spiculated nodule in the lower lobe of the emphysematous native right lung (arrow).
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Post-transplant lymphoproliferative disorder in double lung transplant recipient. Contrast-enhanced CT scan shows low attenuation mass (arrow) in the anterior mediastinum.
