What is a lung transplant?

What is a Lung Transplant?

A lung transplant is the process of removing diseased lungs from a terminally ill individual, and replacing the diseased lungs with healthy ones, usually from a deceased individual.  A lung transplant can be a life saving treatment. However, the potential benefits do not come from the surgery alone. Rather, they depend on you following the rigorous treatment plan prescribed by your doctor. You must be aware of the potential risks and complications that can result in serious injury or death. The operation is complex and the risks are high.

What Are the Risks of Lung Transplant?

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 for complications is the highest.
In recent years, short-term survival from lung transplant has improved.  The major complications of lung transplant are rejection and infection.  Rejection means that 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 called immunosuppressants to suppress your immune system. You will need to take these medicines for the rest of your life. This involves around 20 pills daily.  These must be taken within a ½ hour of the same time twice daily.  Rejection is most common in the first 6 months after surgery, but it can happen any time after the transplant.  Rejection can develop slowly or suddenly. Your doctor will teach you how to recognize possible signs and symptoms of rejection. If you know these signs and symptoms, you can seek treatment right away.  These medicines may cause side effects, such as headaches, nausea (feeling sick to your stomach), and flu-like symptoms. If you have side effects, talk to your doctors. They may be able to change your medicine or adjust the doses.

The medicines you take to prevent the rejection of your new lung will 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.  Other risks are that long-term use of immunosuppressants can cause diabetes, kidney damage, andosteoporosis (thinning of the bones). These medicines also can increase the risk of cancer. Talk to your doctor about the long-term risks of using immunosuppressants.

The biggest risk and cause of most deaths is ACUTE REJECTION. It happens most commonly in the first 12 months after transplant. Prevention of and monitoring for rejection is intense in the first year. Rejection often has no symptoms unless it is very serious, so lab work to monitor levels of the rejection drugs, pulmonary function testing, and lung biopsies will be done regularly during that first year when the risk is the highest. Every attempt is made to manage patients on the lowest amount of rejection medications in order to keep their immune system as strong as possible to prevent from infections.

Long term affects include CHRONIC REJECTION. Frequent pulmonary function tests are performed to look for evidence of chronic rejection. Chronic rejection is the main cause of death of lung transplant patients at 5 years post-transplant.

Long Term Affects

You will be a patient of the lung transplant clinic for the rest of your life. You will also have a primary care physician in your community for routine non-transplant medical care. For most patients, follow up involves frequent lab work and clinical visits 1 to 2 times per week for the first 2 months. The interval between visits will gradually decrease to a monthly visit. Patients who develop complications will need to be seen more often by the transplant team.

National Survival Ratings from Lung Transplant Surgery Statistics

83% of people survive 1 year

53% of people survive 5 years

28% of people survive 10 years

The Transplant Operation

When a donor’s lungs become available, you will be called, and you must come to the hospital RIGHT AWAY.  Medication will be given immediately to help prevent infection before you go to surgery. A dose of anti-rejection will be given immediately before the surgery as well. Your family will be allowed to be with you before the surgery. Lung transplant surgery takes from 9-12 hours total.

If the transplant surgeon feels that there could be increased risk to you due to the quality of the donor organ or the donor’s medical or social history, this will be discussed with the transplant pulmonologist and with you.At the time of the lung offer, your surgeon will have a clear picture of the risks associated with this particular set of lungs versus your medical risks associated with waiting for the next available donor. You will be given their recommendation based on that information, and will have the option to decline their offer if you so choose.

After you have been called into the hospital for the surgery, there is always the possibility that the surgery may not happen. Even if everything about the organ appears good, the surgeon may find something concerning when the lungs are being removed from the donor. In this case, the surgeon and pulmonologist will discuss the findings and may decide not to accept the lungs. It is also possible that you, the potential recipient may have something going on that would prevent a transplant. (Such as an infection) You will be kept informed of the status of the transplant by the nurse coordinator.

The surgery will be done under general anesthesia. This means that you will be given medications to put you to sleep, block pain, and paralyze your body. A tube will be put down your throat into your lungs and you will be attached to a machine that will breathe for you. There are a number of known possible risks of a surgery done under general anesthesia. The anesthesiologist will talk to you more in detail about the risks of being under general anesthesia and you will be asked to sign a separate consent form.

Once your transplant team has determined your condition is stable after surgery, you will be transferred from the ICU to your room in the Transplant Unit. At times during your recovery, you might need to return to the ICU for specialized monitoring to ensure your best recovery.

Will I be in pain after the transplant?

As you recover and “wake up” from the anesthesia, you will experience pain and/or nausea. You also will feel pain at your incision sites.  In most cases, your pain will be managed by a patient-controlled pain pump to make you as comfortable as possible. The pain pump has a hand-held button that will allow you to deliver pain medicine (as prescribed by your doctor) directly into your IV on demand (when you decide you need it). After a few days, your discomfort should gradually decrease.

Breathing exercises and activity are critical.  A health care provider will show you how to do deep breathing exercises with an incentive spirometer. An incentive spirometer is a breathing aid to help keep your lungs clear and active while you are recovering from surgery.  You also will be asked to cough frequently. Because coughing will put pressure on your incision and might be painful, we recommend holding a pillow against your chest while you cough. Coughing helps remove secretions from your lungs to prevent infection.  It is important to change positions and move your legs and feet often during your recovery to maintain your circulation and improve your strength. The nurse will help you with these activities.

As soon as possible after surgery, your nurse will help you get out of bed and walk in the hallway. Your family and friends can walk with you when they visit. Stop and rest whenever you feel tired, but try to increase the distance you walk a little every day.

What is the daily hospital routine?

Initially, a member of the surgical team will visit you to tell you about the surgery. Every day while you are in the hospital, you can expect early morning visits, as well as periodic visits at night, from your doctors. Your transplant coordinator also will check on your progress frequently throughout the day.  The dressing over your incision will be changed, and blood samples will be taken every morning. The blood samples are tested in a laboratory, and the results indicate how well your new lung is working.  Your weight will be checked every day. Your weight reflects your fluid level and how well your kidneys are functioning.

Every day, you will gradually increase your activity. You also will continue to learn more about your medicines and daily health care in preparation for your recovery at home.  Although you might find it difficult to be so dependent on your health care providers for your daily needs, you must remember that they are specially trained and know what type of care you need. You should be reassured that your health care providers are doing everything possible to help you regain your health.