Transplant Primer: Lung Transplant

Section 1: Introduction to Transplantation	Section 4: Liver Transplant
Section 2: Heart Transplant	Section 5: Lung Transplant
Section 3: Kidney Transplant	Section 6: Pancreas Transplant

Lung Transplant

Important! Nothing on this page is medical advice. If you need a transplant, please seek the advice and care of qualified transplant physicians. This is a general source of information and does not represent a medical opinion or recommendation.

Doctors may recommend a lung transplant to treat lung failure. Failure may be due to disease, and two of the most common categories of disease are emphysema and pulmonary fibrosis. The person who needs the transplant is evaluated by a lung transplant team and if they are found to be suitable his or her name is placed on the wait list. When a donated lung becomes available, it is surgically removed from the donor and transplanted into the patient. The lung transplant can either be single lung or a double lung transplant.

Among 1,692 patients who underwent lung transplants in 1997 and 1998, about 59% survived for at least three years afterwards.

Step 1: Evaluating candidates for lung transplantation
A team of specially trained staff evaluates the patient to establish whether he or she would be a good candidate for a lung transplant. The staff includes people with special skills in a range of areas. The people who may be on the team include:

Pulmonologists (medical lung specialists)
Transplant surgeons
Social workers, psychologists, and/or psychiatrists
Nurses
Transplant coordinators

A lung transplant is only offered to people who have irreversible lung failure. These people will not live longer than 1 to 2 years unless they receive a lung transplant. Other medical or surgical treatments for cardiac problems have usually been tried before consideration of lung transplants. The lung failure may have been caused by problems such as:

Emphysema, a chronic lung disease
Pulmonary fibrosis, a group of respiratory diseases that are associated with scarring
Cystic fibrosis, an inherited disease that affects the respiratory and digestive systems
Alpha-1-antitrypsin deficiency, a deficiency of a protein produced in the liver that is associated with emphysema and liver disease
Pulmonary hypertension, a condition in which pressure in the blood vessels of the lungs increases. This increased pressure causes damage to the blood vessels and heart.

Successful lung transplants have been conducted on newborn infants, children and adults including people past the age of 60.

The evaluating team considers many factors to decide whether a person should be placed on the wait list for a transplant. The person's general health and suitability for major surgery are taken into account. Risk factors are considered carefully and may result in a recommendation against transplant surgery.

A lung transplant would not be performed for people with certain conditions. These include:

Most cancers, unless successfully treated at least five years previously
Infections that cannot be completely treated or cured, such as tuberculosis
Severe heart, liver or kidney problems that would make the operation too risky

It is a normal reaction of the body to reject the donated organ. Anti-rejection drugs are prescribed to prevent this rejection. The candidate must be willing to take anti-rejection medicines indefinitely to keep the body from rejecting the donor lung. The person will also need lifelong follow-up by health care professionals.

Step 2: Waiting
If a person is a suitable candidate for a lung transplant, their name is put on a waiting list for an organ. Unfortunately, there are many more people on the wait list than there are organs available each year. There are currently more than 3,800 people in the U.S. waiting for a donor lung. Waiting time may extend several years.

Lungs are allocated based on the length of time a person has been on the waitlist and blood type.

Step 3: The Transplant Surgery
When a donor lung becomes available, time is critical. The lung must be transplanted into the patient receiving the organ within 4 to 6 hours. A team of surgeons and anesthesiologists performs an operation to remove the lung from the donor. Additional surgical teams may be present to remove other organs. After the lung is removed from the donor, it is preserved and packed for transport. Although the donor is brain dead, this procedure is treated like any other operation using standard surgical practices and sterile techniques. Once the operation is complete and the incisions are closed, the donor's body is prepared for funeral or cremation. Organ procurement surgery respects the body and an open casket funeral is possible if desired.

Typically, both lungs are removed from the donor together. If the recipient is in need of a double lung transplant, both lungs will be transplanted. Otherwise, the lungs are usually separated after they are removed from the donor and used for two single lung transplant recipients.

In the meantime, a recipient is located and prepared for surgery as well. Preparation involves administration of general anesthesia, and placement on an artificial breathing machine. The transplant of the lung begins with removal of the diseased lung and the blood vessel attachments to the heart and large airway (bronchus). When the lung is placed within the recipient, the blood vessels and bronchus from the donor lung must now be connected to the recipient's corresponding blood vessels and bronchus. Next, the blood flow and airflow are restored. After the transplant is complete the incision is closed. The patient will begin recovery in the intensive care unit (ICU).

When a double lung transplant is performed, it is much like two single lung transplants. The lung that is more diseased is transplanted first and then the less diseased lung is transplanted.

Step 4: After Transplant Surgery
Following lung transplant surgery, the patient may remain on an artificial breathing machine for the first 12 hours of recovery. However, if the donor lung is functioning properly, the artificial breathing machine may be removed at the end of surgery. Depending on progress, some patients are moved out of the ICU in a few days. Generally, he or she will also begin eating within the week following surgery. Total hospital stay is typically 7 to 10 days.

Because the organ will be identified as foreign by the recipient's immune system, rejection of the new lung is always a possibility. Powerful drugs called immunosuppressants are given starting at the time of lung transplant surgery to try to prevent rejection. Within the first few weeks following transplantation, blood tests are done to confirm that correct dosage of medication is being dispensed.

Prior to discharge, the transplant team reviews information with the patient, gives instructions for follow-up care and medications, and answers the patient's questions. A prescribed rehabilitation program will continue at home including physical activity, breathing exercises, nutrition, and the continuation of immunosuppression and other medications. The signs of rejection are also discussed with the patient and family.

Step 5: Returning Home
At-home rehabilitation for lung transplantation is a gradual process, and depends on the individual. The transplant team will give specific instructions. In general, walking is recommended to restore strength and prevent lung complications, but heavy lifting should be avoided for four to six weeks following transplant surgery. Other activities, such as driving may usually begin when the incision heals. Sexual activity can resume when one is comfortable. A desire to become pregnant should be discussed ahead of time with the transplant team to determine if and when this is recommended.

Follow-up visits are required for check-ups. These begin soon after returning home. Initially, outpatient visits may occur weekly or even more often, and as time progresses the frequency of follow-up visits usually decreases.

Possible post-operative complications may arise following lung transplant surgery. They include:

Major bleeding
Pneumonia
Pulmonary edema

Major bleeding - Rarely the patient may experience bleeding after surgery. Patients may require an additional operation to resolve the bleeding problem or remove blood clots.

Pneumonia - Infection in the transplanted lung can be life-threatening.

Pulmonary edema - The donor lung may accumulate fluid that prevents the effective exchange of oxygen and carbon dioxide.

Other problems include the long-term risks of immunosupression. These include complications related to too much or too little immunosuppression:

Rejection
Cancer
Infection

Rejection - It is fairly common for a transplant patient to experience rejection episodes. The body identifies the new organ as foreign and may try to reject it. The immunosuppressive medications prevent rejection in 50 to 75% of cases. Changes may be made in the medications including an increase in dosage or the use of additional drugs to stop the rejection. Some episodes can cause permanent damage to the new lung. This may reduce longevity of the organ.

Cancer - Studies show that an estimated 6% to 8% of transplant patients will develop cancer over their lifetime with the transplant. This risk is higher than in the general population. Skin cancer is the most common, and is typically treated successfully. Some cancers result from the effects of the immunosuppressive medications and others are common cancers that occur at a higher rate in immunosuppressed individuals.

Infection - The immunosuppressant medications increase the risk of less serious and common infections such as urinary tract infection. In addition, they are associated with more serious and potentially life-threatening infections like pneumonia. Finally, uncommon infections that do not affect non-immunosuppressed persons can occur.

Section 4: Liver Transplant

Section 6: Pancreas Transplant