Lung Transplantation Health Article

Aftercare

Transplantation requires a long hospital stay, and recovery can last up to six months. Careful monitoring will take place in a recovery room immediately following the surgery and in the patient's hospital room. Patients must take immunosuppressive, or anti-rejection, drugs to reduce the risk of rejection of the transplanted organ. The body considers the new organ an invader and will fight its presence. The anti-rejection drugs lower the body's immune function in order to improve acceptance of the new organs. This also makes the patient more susceptible to infection.

Frequent check-ups, including x ray and blood tests, will be necessary following surgery, probably for a period of several years.

Risks

Lung transplantation is a complicated and risky procedure, partly because of the organs and systems involved, and also because of the risk of rejection by the recipient's body. Acute rejection most often occurs within the first four months following surgery, but may occur years later. Infection is a substantial risk for organ recipients. An early complication of the surgery can be poor healing of the bronchial and tracheal openings created during the surgery. A late complication and risk is chronic rejection. This can result in inflammation of the bronchial tubes or in late infection from the prolonged use of immunosuppressive drugs to fight rejection.

Normal results

Demonstration of normal results for lung transplantation patients include adequate lung function and improved quality of life, as well as lack of infection and rejection.

Morbidity and mortality rates

According to the Scientific Registry of Transplant Recipients (SRTR), a total of 1,076 lung transplants and 31 heart-lungs transplants were performed in the United States in 2002. Of these transplants, 1,041 lungs were obtained from deceased donors and 35 from living donors. The survival rate at one year after transplant was 77% for lung transplants and 64% for heart-lung transplants.

See also Heart transplantation; Thoracotomy.

BOOKS

Couture, K. A. The Lung Transplantation Handbook: A Guide For Patients, 2nd edition. Victoria, BC: Trafford, 2001.

Hertz, M. I., R. M. Bolman, and J. M. Dunitz. Manual of Lung Transplant Medical Care. Minneapolis, MN: Fairview Press, 2001.

Maurer, Janet R., Ronald F. Grossman, and Noel Zamel. "Lung Transplantation." In Textbook of Respiratory Medicine, 2nd edition, edited by John F. Murray and Jay A. Nadel. Philadelphia: W. B. Saunders Co., 1994.

Schum, J. M. Taking Flight: Inspirational Stories in Lung Transplanation. Victoria, BC: Trafford, 2002.

PERIODICALS

Algar, F. J., et al. "Lung Transplantation in Patients under Mechanical Ventilation." Transplantation Proceedings, 35 (March 2003): 737–738.

Burns, K. E., B. A. Johnson, and A. T. Iacono. "Diagnostic Properties of Transbronchial Biopsy in Lung Transplant Recipients Who Require Mechanical Ventilation." Journal of Heart and Lung Transplantation, 22 (March 2003): 267–275.

Chan, K. M., and S. A. Allen. "Infectious Pulmonary Complications in Lung Transplant Recipients." Seminars in Respiratory Infections, 17 (December 2002): 291–302.

Helmi, M., R. B. Love, D. Welter, R. D. Cornwell, and K. C. Meyer. " Aspergillus Infection in Lung Transplant Recipients with Cystic Fibrosis: Risk Factors and Outcomes Comparison to Other Types of Transplant Recipients." Chest, 123 (March 2003): 800–808.

Kyle, U. G., L. Nicod, J. A. Romand, D. O. Slosman, A. Spiliopoulos, and C. Pichard. "Four-year Follow-up of Body Composition in Lung Transplant Patients." Transplantation, 75 (March 2003): 821–828.

Van Der Woude, B. T., et al. "Peripheral Muscle Force and Exercise Capacity in Lung Transplant Candidates." International Journal of Rehabilitation Research, 25 (December 2002): 351–355.

ORGANIZATIONS

American Society of Transplantation (AST). 17000 Commerce Parkway, Suite C, Mount Laurel, NJ 08054. (856) 439-9986. <http://www.a-s-t.org>.

Children's Organ Transplant Association, Inc. 2501 COTA Drive, Bloomington, IN 47403. (800) 366-2682. <http://www.cota.org>.

The National Heart, Lung, and Blood Institute (NHLBI). P.O. Box 30105, Bethesda, MD 20824-0105. (301) 592-8573. <http://www.nhlbi.nih.gov/index.htm>.

Second Wind Lung Transplant Association, Inc. 9030 West Lakeview Court, Crystal River, FL 34428. (888) 222-2690. <http://www.arthouse.com/secondwind>.

OTHER

"Lung Transplantation." The Brigham Women's Hospital. <http://www.cheshire-med.com/programs/pulrehab/transplant.html>.

"Lung Transplantation." Medline Plus. <http://www.nlm.nih.gov/medlineplus/lungtransplantation.html>.

Teresa Norris, RN
Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Lung transplantations are performed in a specialized organ transplantation hospital. Every transplant hospital in the United States is a member of the United Network for Organ Sharing (UNOS) and must meet specific requirements.

Lung transplantations involve specialized transplant teams usually consisting of an anesthesiologist, an infectious disease specialist, a thoracic surgeon, an ear, nose, and throat (ENT) specialist, a cardiologist, and a transplant dietician who all perform with a high level of coordination.

QUESTIONS TO ASK THE DOCTOR

• Are there organizations who can help me afford the cost of transplantation?
• How does the lung matching process work?
• How do I get on the lung waiting list?
• How will they find the right donor for me?
• How many lung transplantations do you perform each year?
• What happens during transplantation?