Pneumonectomy after transplant

[Lomack]

My mother in law suffers from Alpha I Anti-tripson Disease and has undergone two lung transplants in the last 10 years.  She is currently on antibiotics to treat an infection in her left lung.  The top portion of her left lung has already collapsed.  The infection is so severe that it is crossing over into the right lung which is only in mild rejection at this time and is looking rather good.  She currently has a central line in and is running antibiotics three times a day to see if it has any effect on the infection.  After significant battles she is now faced with the decision of whether or not to have a pneumonectomy on one of the transplanted lungs.  She has not been given very positive statistics for this procedure at her current hospital.  I am wondering if you have any information, or can point me in the right direction, as to where I can find information regarding this procedure on an individual who is a double lung transplant patient.  We are trying to find better statistics, possibly in another hospital or with another Doctor that may be able to help her.  I would appreciate any information you can give me regarding this matter.  Unfortunately, time is of the essence.  Thank you in advance for your help.

[National Jewish]

Your question seeks specific information about the risks and benefits of pneumonectomy for severe lung infection in your mother-in-law, who received a double lung transplant for emphysema due to Alpha-1 Antitrypsin Deficiency.  Unfortunately, this procedure is rarely necessary and therefore it is extremely unlikely that you will find any transplant center that has extensive experience performing this procedure in this setting.  Further, it is impossible to evaluate the risks and benefits in your mother-in-law's specific case without being involved in her actual care.
There are some comments and suggestions that can be made, however.  If it is necessary to remove a lobe or lung in this setting, and the remaining lung tissue is functioning well, there is every reason to believe that your mother-in-law's respiratory status could be improved by this surgery, compared with her current condition.  There are many patients with Alpha-1 Antitrypsin Deficiency who receive only a single lung transplant and do extremely well.  To a certain extent, this would be the situation in your mother following pneumonectomy.
I would also raise an additional point to you, your mother, and her physicians.  When an individual with a lung transplant due to Alpha-1 Antitrypsin Deficiency has ongoing severe lung inflammation, as in a lung infection, it may be advisable to consider instituting augmentation therapy with Prolastin (pooled human plasma alpha-1 antitrypsin).  Since the lung destruction of Alpha-1 Antitrypsin Deficiency is caused by proteases released in large amounts during inflammatory processes, protection of the transplanted lungs by replenishing the Alpha-1 screen in the blood with Prolastin may be helpful.
I hope this information is useful to you in your decision-making and I hope that your mother-in-law recovers successfully from this setback.