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, the Harold L. and Margaret N. Method Professor of Surgery, and professor of pulmonary and critical care at Northwestern Medicine Feinberg School of Medicine in Chicago, Illinois, discussed the potential adverse effect (AE) profile of double lung transplantation and potential complications that may result from the surgery as well as how they might be managed.

He began by expressing that lung transplantation is one of the more complex surgeries that Northwestern offers for patients undergoing treatment for advanced lung cancers. He further expressed that although surgical fatalities are not generally observed with double lung transplantation and catastrophic complications are highly infrequent, medications may help prevent a patient's immune system from rejecting the new organ.

Bharat explained that the short-term AEs of these medications are immunosuppression, but longer-term AEs may appear as a result of kidney, immune system, and bone marrow damage, with chronic lung rejection possibly occurring unrelated to the medication. He concluded by emphasizing that patient adherence may help to mitigate these AEs, and he highlighted the role of his team in counseling patients about 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 do. There are certain risks. We talk about those with the patient. Fortunately, at Northwestern, we have high-level experience [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] effect.

Short term, they could have [adverse] effects that [weaken] the 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, such as [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 adherent to medication, [as] those complications do tend to occur more commonly when you’re not being adherent, 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.