What is the surgical treatment option for end-stage cystic fibrosis?

What is the surgical treatment option for end-stage cystic fibrosis?

• A. Double lung transplantation
• B. Single lung transplantation
• C. Lobectomy
• D. Wedge resection

Answer: (A)

In end-stage cystic fibrosis, the surgical option that offers the best chance for meaningful, durable improvement is replacing both lungs with donor lungs. CF causes diffuse disease of the airways in both lungs, with widespread bronchiectasis and chronic infections. If only one lung is transplanted, the remaining native lung, still laden with mucus-producing airways and pathogens, can continue to drive infection and inflammation and may compromise the new lung. This can lead to recurrent infections in the transplanted graft, uneven function, and worse long-term outcomes. Double-lung transplantation eliminates the diseased native airways in both lungs, providing more uniform respiratory function, reducing the risk of cross-infection from native airways to the donor lung, and generally offering better survival and quality of life for CF patients. Lobectomy or wedge resection target localized lesions and do not address the global, progressive lung failure seen in CF, so they are not appropriate for end-stage disease. Single-lung transplantation, while possible in some contexts, has historically shown poorer outcomes in CF due to the remaining diseased lung, making it less favorable than replacing both lungs.

In end-stage cystic fibrosis, the surgical option that offers the best chance for meaningful, durable improvement is replacing both lungs with donor lungs. CF causes diffuse disease of the airways in both lungs, with widespread bronchiectasis and chronic infections. If only one lung is transplanted, the remaining native lung, still laden with mucus-producing airways and pathogens, can continue to drive infection and inflammation and may compromise the new lung. This can lead to recurrent infections in the transplanted graft, uneven function, and worse long-term outcomes.

Double-lung transplantation eliminates the diseased native airways in both lungs, providing more uniform respiratory function, reducing the risk of cross-infection from native airways to the donor lung, and generally offering better survival and quality of life for CF patients.

Lobectomy or wedge resection target localized lesions and do not address the global, progressive lung failure seen in CF, so they are not appropriate for end-stage disease. Single-lung transplantation, while possible in some contexts, has historically shown poorer outcomes in CF due to the remaining diseased lung, making it less favorable than replacing both lungs.