Share on:
Lung transplantation is more than the operation. The evaluation, waiting for a transplant and recovery afterward represent a long journey for you and your family. While most people have an excellent outcome, some lifestyle changes are necessary for continued health after transplantation.
Potential lung transplant candidates must undergo detailed physical, laboratory and psychological testing to determine whether they would benefit from lung transplantation or another option. The typical evaluation takes a few days and includes assessing the lungs, heart, kidney, liver and immune system.
The transplant team evaluates your test results to determine the likelihood of a successful transplant. The team includes pulmonary transplant doctors and surgeons as well as specialists from cardiology, infectious diseases, psychiatry and other areas. Certified transplant coordinators and licensed social workers assist the transplant candidate and family during and after the evaluation.
After testing, you return for a visit with the transplant doctors to discuss the outcome of the evaluation. If the treatment team decides you are a good candidate, you will be added to the lung transplant waiting list. Those not considered candidates for transplantation will be offered alternative medical or surgical care, if available.
The costs of lung transplantation may be covered by a health insurance policy, a managed care plan, a government medical assistance plan or by other means. Mayo Clinic social workers and financial counselors routinely meet with you and your family during the initial evaluation for transplant. They explain the options available. Mayo Clinic has contracts with several managed care providers.
When you are approved for transplant, you are placed on the active waiting list and are given a pager to notify you when a donor organ becomes available. Transplant recipients usually have two to three hours to reach the hospital to prepare for surgery. Transplant candidates must live close enough to arrive at the hospital in that time frame.
Transplant candidates are evaluated every three months or more regularly, if necessary. Regular communication between the transplant team and the referring physician is essential for successful shared care.
Mayo Clinic helps you coordinate any necessary air transportation to ensure rapid travel to Mayo Clinic when a donor organ becomes available.
After notice is received that a compatible donor organ is available, you will be admitted to the hospital. The transplant physician will do a final evaluation to ensure you are still in appropriate condition for transplantation.
Before making the final decision to proceed with a transplant, the surgeon retrieving the lung (or lungs) carefully examines it to make sure it's viable. Surgery on the transplant recipient is not begun until the surgeon retrieving the organ approves it for transplant. It's possible that a candidate could be admitted to the hospital and even be in the operating room and have the procedure canceled because the donor lung was not viable. This process is called a "dry run." It's important to be emotionally prepared to deal with this situation. Doing a last-minute check on donor organ viability improves the likelihood of a successful transplant.
Once the donor lung is declared viable, the team will begin surgery. Meanwhile, the retrieval surgeon preserves the lung, transports it to the hospital and joins the transplant surgery in progress.
The following general information usually applies, though each person's situation is unique:
Lung transplant recipients usually stay in the hospital for three to four weeks. Education and physical rehabilitation begin soon after surgery and continue in the outpatient pulmonary transplant rehabilitation program after you leave the hospital.
In the early post-hospital phase, Mayo's transplant team sees transplant recipients several times a week. Eventually these visits decrease to one a month. Transplant recipients will be asked to remain in the Mayo Clinic area for two to three months following transplantation to allow Mayo's transplant team to closely monitor their status. Transplant recipients and their families participate in educational activities to help them feel comfortable with taking medications, monitoring blood pressure and measuring lung function.
You will need to take medications daily for the rest of your life to keep your immune system from rejecting the transplanted tissue. The threat of acute rejection is highest in the first six months after surgery. To screen for signs of rejection, transplant recipients undergo routine chest X-rays and lung function measurements such as spirometry and pulse oximetry.
If organ rejection is suspected, samples of lung tissue are tested to determine whether rejection has begun or another problem, such as an infection, is developing. This procedure is called a bronchoscopy with transbronchial biopsies. Lung transplant recipients undergo screening bronchoscopies and biopsies at one, three, six and 12 months after transplantation and whenever signs of rejection are present. These procedures are done under sedation.
Most people are treated with three immunosuppressive drugs. These medications usually require frequent adjustments, especially soon after transplant. The medications must be given in doses high enough to avoid acute rejection but not so high that you become vulnerable to infections. Because the likelihood of developing infections soon after transplant is high, you also receive protective antibiotics to prevent the most common infections that occur after transplant. As your body becomes more tolerant of the new lung, doses of immunosuppressive drugs are progressively lowered, and protective antibiotics slowly discontinued.
When your health is stable and you have returned home, you should see your primary care doctor regularly. You will need to test your lung volume every day for life. Each transplant recipient is given equipment to test lung volume and instructed in its use. Test results are transmitted to the transplant center each day. These measurements provide important information about how well the lungs are working. A decline in the measurements is a signal that you should be re-evaluated.
Because transplant recipients must take medications that suppress their immune system, they are vulnerable to developing complications from infections. You and your primary care doctor must be vigilant for signs of infections that should be treated early and aggressively.
Additional complications of lung transplantation, usually caused by side effects of immunosuppressive therapy, include:
Medications are available to help manage these problems, but a healthy lifestyle, proper diet and exercise are equally important.
Lung function is also monitored to identify and treat possible chronic rejection (also called bronchiolitis obliterans), which is characterized by a slow increase in breathlessness.
Immunosuppressive therapy also makes you more prone to developing tumors and cancer. Therefore, it's important to maintain a healthy lifestyle, proper diet, strict avoidance of tobacco products and regular checkups to screen for common preventable cancers, such as breast, cervix, colon and prostate cancers.
Share on:
.
Find Mayo Clinic on