Elucidating the Safety Profile of Double Lung Transplantation

In an interview with CancerNetwork®, Ankit Bharat, MBBS, chief of Thoracic Surgery in the Department of Surgery, Harold L. and Margaret N. Method Professor of Surgery, and professor of Pulmonary and Critical Care at Northwestern Medicine Feinberg School of Medicine, spoke about the potential adverse effect (AE) profile of double lung transplantation, as well as potential complications that may result from the surgery, as well as how they might be managed.

He began by expressing that lung transplantation was one of the more complex surgeries that Northwestern offers for patients undergoing treatment for advanced lung cancers. He further expressed that while surgical fatalities are not observed with double lung transplantation, and catastrophic complications are highly infrequent, he suggested that medications taken may help prevent their immune system from rejecting the new organ.

Bharat explained that the short-term AEs of these medications are immunosuppression, but that longer-term AEs may come at the hands of kidney, immune system, and bone marrow damage, with chronic lung rejection possibly occurring unrelated to the medication. He concluded by emphasizing that patient compliance may help to mitigate these AEs and highlighted the role of his team to counsel patients regarding proper medication use. His team also monitors for complications or AEs developing and then modifies the treatment strategy to avoid them.

Transcript:

Lung transplantation is one of the most complex surgeries we can do. There are certain risks. We talk about those with the patient. Fortunately, at Northwestern, we have high-level experience [enough so] that they do not die on the table, or early on, have catastrophic surgery-related complications, but these patients do require medications to keep the immune system that they have from rejecting the new lungs. Those medications do have a certain type of [adverse] effects.

Short term, they could have [adverse] effects that [weaken] your immune system. Long term, they can have what we call chronic rejection of their lungs, which is not controlled by these medications. Then there are certain [adverse] effects, like [kidney, immune system, and bone marrow damage] that can occur. What we do is thoroughly try to counsel the patients and ensure that they are being compliant with medication, [as] those complications do tend to occur more commonly when you’re not being compliant, meaning some days you may take too much, some days you are taking less. Being consistent reduces the risk. We make sure we counsel the patient, and we closely monitor in case you see signs of complications or adverse effects developing–we [modify] the strategy so we can avoid that.