A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. Depending on your medical condition, a lung transplant may involve replacing one of your lungs or both of them. In some situations, the lungs may be transplanted along with a donor heart.
Living-donor lung transplants are rare. This procedure can replace a child's diseased lung with a section (lobe) of a lung taken from a healthy adult — usually a parent. Two living donors are needed if the procedure is used for an adult.
Unhealthy or damaged lungs can make it difficult for your body to get the oxygen it needs to survive. A variety of diseases and conditions can damage your lungs and hinder their ability to function effectively, including:
- Chronic obstructive pulmonary disease (COPD), including emphysema
- Scarring of the lungs (pulmonary fibrosis)
- Cystic fibrosis
- Sarcoidosis with advanced fibrosis
- Pulmonary hypertension
Lung damage can often be treated with medication or with special breathing devices. But, when these measures no longer help or your lung function becomes life-threatening, your doctor might suggest a lung transplant.
Complications associated with a lung transplant can sometimes be fatal. The two major risks are rejection and infection.
Risk of rejection
Your immune system defends your body against foreign substances. Even with the best possible match between you and the donor, your immune system will try to attack and reject your new lung or lungs. Your drug regimen after transplant will include medications to suppress your immune system in an effort to prevent organ rejection. You'll likely take these anti-rejection drugs for the rest of your life.
Side effects of anti-rejection drugs
Anti-rejection drugs may cause noticeable side effects, including:
- Weight gain
- A rounder face
- Facial hair
- Stomach problems
Some anti-rejection medications can also increase your risk of developing new or aggravating existing conditions, such as:
- Kidney damage
Risk of infection
The anti-rejection drugs suppress your immune system, making your body more vulnerable to infections, particularly in your lungs. To help prevent infections, you should:
- Wash your hands often
- Take care of your teeth and gums
- Protect your skin from scratches and sores
- Avoid crowds and people who are ill
- Receive appropriate immunizations
The number of people needing lung transplants far exceeds the number of donated lungs available. When a donor organ becomes available, the donor-recipient matching system administered by the United Network for Organ Sharing (UNOS) finds an appropriate match based on specific criteria, including:
- Blood type
- Size of organ compared with chest cavity
- Geographic distance between donor organ and transplant recipient
- Severity of the recipient's lung disease
- Recipient's overall health
- Likelihood that the transplant will be successful
While you wait
It may take months or even years before a suitable donor becomes available, but you must be prepared to act quickly when one does. Make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy — including an extra 24-hour supply of your medications — and arrange transportation to the transplant center in advance. You may be expected to arrive at the hospital within just a few hours.
At the hospital
Once you arrive at the hospital, you will undergo tests to make sure the lung is a good match and that you are healthy enough to have the surgery. The donor lung also must be healthy or it will be declined by the transplant team. The transplant will be canceled if it doesn't appear that the surgery will be a success.
During your lung transplant
The procedure will be done under general anesthesia, so you'll be asleep and you won't feel any pain. Doctors will insert a tube through your mouth and into your windpipe to help you breathe. You will also have a tube in your nose down to your stomach to drain your stomach contents. A catheter will keep your bladder empty.
Your surgeon will make a cut in your chest to remove your diseased lung. The main airway to that lung and the blood vessels between that lung and your heart will then be connected to the donor lung. For some lung transplants, you may be connected to a heart-lung machine, which circulates your blood during the operation.
A single-lung transplant takes about four to eight hours to complete, while a double-lung transplant usually takes six to 12 hours.
After your lung transplant
Immediately after the surgery, you'll spend several days in the hospital's intensive care unit. A mechanical ventilator will help you breathe for a few days and tubes in your chest will drain fluids from around your lungs and heart. A tube in a vein will deliver strong medications to control pain and to prevent rejection of your new lung. As your condition improves, you'll no longer need the mechanical ventilator and you'll be moved out of the intensive care unit. Recovery often involves a one- to three-week hospital stay.
After you're discharged from the hospital, you'll require about three months of frequent monitoring by the lung transplant team to prevent, detect and treat complications and to assess your lung function. During this time, you'll need to stay close to the transplant center. Your follow-up visits may involve laboratory tests, chest X-rays, an electrocardiogram (ECG) and checkups with a specialist.
Living a healthy lifestyle is key to sustaining your new lung. Smoking isn't allowed, and the use of alcohol is strictly limited. Following a nutritious diet also can help you stay healthy. Exercise is an extremely important part of rehabilitation after your lung transplant and will begin within days of your surgery. Your health care team will work with you to design an exercise program that's right for you.
A lung transplant can substantially improve your quality of life. The first year after the transplant — when surgical complications, rejection and infection pose the greatest threats — is the most critical period. Although some people have lived 10 years or more after a lung transplant, only about half the people who undergo the procedure are still alive after five years.
Apr. 26, 2014
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