A Lung transplant is a surgical removing of a dysfunctional and diseased lung from the patient's body and replaces it with a healthy lung from a donor.
Who Need a Lung Transplant?
Most people with severe and end-stage lung disease are considered for a lung transplant. The procedure is considered when someone seems likely to die without the surgery, and no other options are available. A person whose lung disease is so severe that they can no longer enjoy life can also be considered for a lung transplant. However, due to certain reasons people with age between 60 to 65 years are not considered for a lung transplant.
People with these lung diseases need to go for lung transplant:
- Chronic obstructive pulmonary disease (chronic bronchitis and emphysema)
- Cystic fibrosis
- Idiopathic pulmonary fibrosis
- Idiopathic pulmonary arterial hypertension
Lung transplant reasons may vary for all people with the above mentioned conditions. For example, in idiopathic pulmonary fibrosis, scar tissue replaces healthy lung and in emphysema, lung tissue is destroyed by smoking.
Lung Transplant Procedure
Preparing for a Lung Transplant
The lung transplant evaluation process is usually complicated and long. Firstly, a doctor needs to refer a patient to a regional transplant center. At the transplant center, doctors, social workers, psychologists, and other staff meet with the person to gather information about him. These meetings may take place on several visits occurring over many weeks and months.
Besides the patient's lung condition, the team also considers the person's financial situation, family and social support, medical conditions or any other psychological conditions.
Many tests are performed during a lung transplant evaluation, which are:
- Cardiac stress test
- Pulmonary function tests
- Bone mineral density test
- Coronary artery catheterization
- Chest X-ray
- CT scan of the chest
- Blood tests for kidney and liver function, and a complete blood count (CBC) and blood type
- Tests for antibodies present in the blood
Doctors usually won't recommend a lung transplant for patients with these conditions:
- Significant heart, kidney or liver disease
- Alcohol or drug abuse
- Ongoing infections
- Anyone who continues to smoke can't be accepted for a lung transplant
Going on the Lung Transplant List
After tests and interviews have been completed and the patient is considered as a good candidate for a lung transplant, he/she will be listed on the national and regional organ recipient lists.
A person's place on the list is determined by his/her Lung Allocation Score. This is a complicated calculation that tries to predict how long a patient can live without a lung transplant and how long he/she would be expected to live if they receive a lung transplant?
People with higher Lung Allocation Score are considered first when donors' lungs become available.
During a Lung Transplant
When a compatible donor's lungs become available, the patient will be called urgently to the transplant center to prepare for the surgery. Surgical team members travel to examine the deceased donor's lungs to make sure they are suitable for transplant. If they find it suitable, surgery on the recipient begins immediately, when the lungs are in transit to the center.
The surgeon may perform either a single lung transplant or a double lung transplant. Each option has some advantages disadvantages, and the choice depends on the patient's lung disease and other factors.
The surgeon will make an incision in the chest. The incision varies by the type of lung transplant:
- An incision on one side of the chest (for a single lung transplant)
- An incision on either side of the chest or across the entire width of the front of the chest (for a double lung transplant)
This surgery is performed under general anesthesia.
Some patients receiving a lung transplant need to go on cardiopulmonary bypass during the surgery. During this bypass, the blood is pumped and enriched with oxygen by a machine, rather than by the heart and lungs.
After a Lung Transplant
The full recovery time after a lung transplant varies widely between people. Some people are fine to leave the hospital within a week, or some may need to be in the hospital for two weeks or longer.
The receiver needs to follow these points for the timely recovery:
- Frequent follow-ups with the doctor
- Follow a new lifelong medication plan
- Regular physical therapy and rehabilitation exercises
- Regular blood tests, chest X-rays, lung function tests, and procedures like bronchoscopy
- The patient is advised to do regular exercises in order to build up their strength.
- After the surgery, for the initial six weeks receiver should avoid pulling, pushing, or lifting anything heavy.
- Four to six weeks after the transplant, the patient will be able to drive.
After a lung transplant, the patient needs to take immunosuppressant for the rest of his life. This is because there is a risk that the body can identify the new lung as a foreign organ, and the patients' immune system can attack it. This is known as rejection syndrome.
Prognosis of lung transplant
Lung transplant is a major surgery that is being performed for people suffering from life-threatening lung disease. After complete recovery from lung transplantation, most of the people do not have any restriction in physical activities. Up to people surviving for five years or more, half of them work at least part-time. Age at the time of transplant is the most important factor for the survival of the transplant.
If you get into a medical center's transplant program, you'll be placed on the Organ Procurement and Transplantation Network's (OPTN's) national waiting list. Your transplant team will work with you to make sure you're ready for the transplant if a donor lung becomes available.
Waiting for a donor lung can be frustrating. However, you can do several things to prepare.
- Go to all of your medical appointments with the transplant team. Take all of your medicines as prescribed.
- Stay as healthy as possible. Don't smoke, and follow your doctor's advice about breathing exercises, physical activity, diet, and drinking alcohol.
- Talk regularly with your transplant team. You and your family should know what to do if a donor lung becomes available. You also should know what to expect before, during, and after the transplant.
- Be ready to go to the transplant center right away if a donor lung becomes available. Make sure the transplant center knows how to reach you at any time, day or night. Your transplant team may give you a pager so they can reach you right away. Make travel and lodging plans in advance. Have a packed suitcase ready to go.
While you wait for a lung, you may feel worried, scared, anxious, or depressed. These feelings are normal in this situation. Talk with your health care team about how you feel. They can offer tips for coping with your emotions. Family and friends also can offer support.
Just before lung transplant surgery, you will get general anesthesia. The term "anesthesia" refers to a loss of feeling and awareness. With general anesthesia, you will be asleep during the surgery and not feel any pain.
Once you're asleep, your doctors will make a small incision (cut) in your chest. Next, they will insert a central venous catheter into a vein. This tube allows easy access to your bloodstream. Doctors use it to deliver fluids and medicines to your body.
Your doctors also will insert a tube in your mouth and down your windpipe to help you breathe. They also will insert a tube in your nose and down to your stomach to drain contents from your stomach. A catheter will be used to keep your bladder empty.
The surgeon will make a cut in your chest to open it. He or she will then cut the main airway to your diseased lung and the blood vessels connecting your lung to your heart.
The surgeon will remove your diseased lung and place the donor organ in your chest. Then the surgeon will connect the main airway of the donor lung to your airway and its blood vessels to your heart.
The illustration shows the process of a lung transplant. In figure A, the airway and blood vessels between a recipient’s diseased right lung and heart are cut. The inset image shows the location of the lungs and heart in the body. In figure B, a healthy donor lung is stitched to the recipient’s blood vessels and airway.
If you're having a double-lung transplant, you may be connected to a heart-lung bypass machine. This machine takes over for your heart and pumps oxygen-rich blood to your body. For more information about the heart-lung bypass machine and an illustration, go to the Diseases and Conditions Index Heart Surgery article.
During a double-lung transplant, the surgeon will remove your diseased lungs, one at a time, and replace them with the donor lungs.
A single-lung transplant usually takes 4 to 8 hours. A double-lung transplant usually takes 6 to 12 hours.
Some people may need a heart–lung transplant. A heart–lung transplant is surgery in which both the heart and lung(s) are replaced with healthy organs from a deceased donor. For this surgery, you're connected to a heart-lung bypass machine.
Recovery in the Hospital
After lung transplant surgery, you'll go to the hospital's intensive care unit (ICU) for at least several days. The tubes that were inserted before surgery will remain for a few days.
The tube in your windpipe helps you breathe. Other tubes deliver medicines to, and drain fluids from, your body. You also will have sticky patches called electrodes attached to your chest to monitor your heart.
After leaving the ICU, you'll go to a hospital room. The staff will carefully oversee your recovery.
You'll be taught how to do deep breathing exercises with an incentive spirometer. This hand-held device helps you take slow, deep breaths. You also may have lung function tests that use a regular spirometer. This device measures how much air your lungs can hold. It also measures how fast you can blow air out of your lungs after taking a deep breath.
You'll need to cough often. Coughing helps clear fluids from your lungs so they can work well. A nurse will show you how to hold a pillow tightly near your incision site while you cough to help decrease discomfort.
Your immune system will regard your new lung as a "foreign object." It will create antibodies (proteins) against the lung. This may cause your body to reject the new organ. To prevent this, your doctor will prescribe medicines to suppress your immune system.
Because these medicines can weaken your immune system, you're more likely to get an infection after the transplant. Your medical team will take steps to prevent infections while you're in the hospital.
On average, people who have a lung transplant stay in the hospital from 1 to 3 weeks. However, some people have complications and stay much longer.
Recovery After Leaving the Hospital
Before you leave the hospital, your medical team will teach you how to keep track of your overall health. You'll learn how to watch your weight and check your blood pressure, pulse, and temperature. Staff also will show you how to check your lung function.
You'll also learn the signs of the two main complications of lung transplant surgery: rejection and infection. (For more information, go to "What Are the Risks of Lung Transplant?")
For the first 3 months after surgery, you'll go to the hospital often for blood tests, chest x rays, lung function tests, and other tests. After 3 months, if you're doing well, you'll visit less often.
Making healthy lifestyle choices is very important. Not smoking, following a healthy diet, and following your doctor's advice on using alcohol will help you recover and stay as healthy as possible.
A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.
Your doctor may recommend pulmonary rehabilitation (PR) after your lung transplant surgery. PR is a broad program that may include exercise training, education, counseling, and more. For more information, go to the Health Topics Pulmonary Rehabilitation article.
Emotional Issues and Support
Having a lung transplant may cause fear, anxiety, and stress. While you're waiting for a lung transplant, you may worry that you won't live long enough to get a new lung. After surgery, you may feel overwhelmed, depressed, or worried about complications.
All of these feelings are normal for someone going through major surgery. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
A lung transplant can improve your quality of life and extend your lifespan. The first year after the transplant is the most critical. This is when the risk of complications is highest.
In recent years, short-term survival after lung transplant has improved. Recent data on single-lung transplants show that:
- About 78 percent of patients survive the first year
- About 63 percent of patients survive 3 years
- About 51 percent of patients survive 5 years
Survival rates for double-lung transplants are slightly better. Recent data show that the median survival for single-lung recipients is 4.6 years. The median survival for double-lung recipients is 6.6 years. Talk with your doctor about what these figures may mean for you.
The major complications of lung transplant are rejection and infection.
Your immune system will regard your new lung as a "foreign object." It will create antibodies (proteins) against the lung. This may cause your body to reject the new organ.
To prevent this, your doctor will prescribe medicines to suppress your immune system. You’ll need to take these medicines for the rest of your life.
Rejection is most common in the first 6 months after surgery, but it can happen any time after the transplant. Rejection can happen slowly or suddenly. Your doctor will teach you how to spot possible signs and symptoms of rejection. If you know these signs and symptoms, you can seek treatment right away.
Signs and symptoms of rejection include:
- Fever and flu-like symptoms
- Chest congestion
- Shortness of breath
- New pain around the lung
- Generally feeling unwell
If you have any of these signs or symptoms, seek medical care. Your doctor may prescribe medicines to treat the rejection and prevent complications.
These medicines may cause side effects, such as headaches, nausea (feeling sick to your stomach), and flu-like symptoms. If you have side effects, tell your doctor. He or she may change your medicines or adjust the doses.
The medicines you take to prevent the rejection of your new lung may weaken your immune system. As a result, you're more likely to get infections.
While you're in the hospital, staff will take special steps to prevent you from getting infections. After you leave the hospital, you also can take steps to prevent infections:
- Wash your hands often.
- Take care of your teeth and gums.
- Protect your skin from scratches and sores.
- Stay away from crowds and from people who have colds and the flu.
Long-term use of medicines that suppress the immune system can cause diabetes, kidney damage, and osteoporosis (thinning of the bones). These medicines also can increase the risk of cancer. Talk with your doctor about the long-term risks of using these medicines.