Manish Mohanka, M.D. Answers Questions On: Lung Transplants

Bronchoscopy is an endoscopic procedure for the lungs. We use a bronchoscope – a black tube with a camera at the end – to look inside the lungs. I perform flexible bronchoscopy, in which I examine the windpipes of a patient.

We use bronchoscopy frequently after lung transplant as a surveillance tool to look for rejection and infections. If we see abnormal spots on a computed tomography (CT) scan, we can sample that area of the lung with a bronchoscopy.

We will also perform the procedure for clinically indicated reasons, such as declined lung function after lung transplant.

One of the biggest problems in lung transplantation is the significant shortage of donated lung organs. We have a large pool of patients awaiting lung transplantation but relatively few available organs. Some patients die before they can get the right organ offers.

There’s been an increase in research into how lungs can be harvested and how their function can be improved or maintained to improve the number of potential organs for transplant. For example, we’re investigating techniques such as ex-vivo (outside the body) lung perfusion that can potentially improve lung function and make lungs available for transplant that wouldn’t have been used before.

The field of lung transplant continues to evolve. We’re still trying to understand the best ways to diagnose rejection among transplant patients. Earlier and more accurate identification of rejection may help us treat these conditions earlier.

There are two main types of acute rejection: acute cellular rejection and humoral rejection. We still lack significant information regarding management of persistent acute cellular rejection. Humoral rejection is a relatively newly understood entity in lung transplantation. Better understanding of these will lead to improvement in therapies, so researchers are focusing on these areas, too.