What is a lung transplant?
A lung transplant is surgery that replaces a diseased or failing lung with a healthy donor lung.
According to data from the Organ Procurement and Transplantation Network, there have been more than 36,100 lung transplants completed in the United States since 1988. The majority of those surgeries were in patients aged 18 to 64 years old.
The survival rate for lung transplant patients has improved in recent years. According to the National Heart, Lung, and Blood Institute (NHLBI), the one-year survival rate of single-lung transplants is nearly 80 percent. The five-year survival rate is more than 50 percent. Those numbers were much lower 20 years ago.
Survival rates vary by facility. When researching where to have your surgery, it’s important to ask about the facility’s survival rates.
Why a lung transplant is done
A lung transplant is considered the last option for treating lung failure. Other treatments and lifestyle changes will almost always be tried first.
Conditions that may damage your lungs enough to require a transplant include:
- chronic obstructive pulmonary disease (COPD)
- cystic fibrosis
- pulmonary fibrosis
- pulmonary hypertension
The risks of a lung transplant
A lung transplant is major surgery. It comes with many risks. Before the surgery, your doctor should discuss with you whether the risks associated with the procedure outweigh the benefits. You should also talk about what you can do to reduce your risks.
The major risk of a lung transplant is organ rejection. This happens when your immune system attacks your donor lung as if it were a disease. Severe rejection could lead to failure of the donated lung.
Other serious complications can arise from the drugs used to prevent rejection. These are called “immunosuppressants.” They work by lowering your immune response, making it less likely that your body will attack the new “foreign” lung.
Immunosuppressants raise your risk of infections, since your body’s “guard” is lowered.
Other risks of lung transplant surgery and the medicines you must take afterward include:
- bleeding and blood clots
- cancer and malignancies due to immunosuppressants
- kidney damage
- stomach problems
- thinning of your bones (osteoporosis)
It’s important to follow your doctor’s instructions before and after your surgery. This can help decrease your risks. Instructions will include making healthy lifestyle choices, such as adopting a healthy diet and not smoking. You should also avoid missing any doses of medications.
How to prepare for a lung transplant
The emotional toll of waiting for a donor lung can be difficult.
Once you’ve undergone the necessary tests and met qualifying criteria, you’ll be placed on a waiting list for a donor lung. Your waiting time on the list depends on the following:
- availability of a matching lung
- blood type
- geographic distance between donor and recipient
- the severity of your condition
- the size of the donor lung
- your overall health
You will undergo numerous laboratory and imaging tests. You may also undergo emotional and financial counseling. Your doctor needs to make sure you’re fully prepared for the aftereffects of the procedure.
Your doctor will give you complete instructions on how to best prepare for your surgery.
If you’re waiting on a donor lung, it’s good to have your bags packed well in advance. The notice that an organ is available could come at any time.
Also, make sure to keep all of your contact information up-to-date at the hospital. They need to be able to contact you when a donor lung is available.
When you’re notified that a donor lung is available, you’ll be instructed to report to the transplant facility immediately.
How a lung transplant is performed
When you and your donor lung arrive at the hospital, you’ll be prepared for surgery. This includes changing into a hospital gown, receiving an IV, and undergoing general anesthesia. This will put you into an induced sleep. You’ll awaken in a recovery room after your new lung is in place.
Your surgical team will insert a tube into your windpipe to help you breathe. Another tube may be inserted into your nose. It will drain your stomach contents. A catheter will be used to keep your bladder empty.
You may also be put on a heart-lung machine. This device pumps your blood and oxygenates it for you during surgery.
Your surgeon will make a large incision in your chest. Through this incision, your old lung will be removed. Your new lung will be connected to your main airway and blood vessels.
When the new lung is working properly, the incision will be closed. You’ll be moved to an intensive care unit (ICU) to recover.
According to the National Hearts, Lung, and Blood Institute (NHLBI), a typical single-lung procedure can take between 4 and 8 hours. A double-lung transfer can take up to 12 hours.
Following up after a lung transplant
You can expect to remain in the ICU for a few days after the procedure. Your vital signs will need to be closely monitored. You’ll likely be hooked up to a mechanical ventilator to help you breathe. Tubes will also be connected to your chest to drain any fluid buildup.
Your entire stay at the hospital could last weeks, but it may be shorter. How long you stay will depend on how well you recover.
Over the next three months, you’ll have regular appointments with your lung transplant team. They’ll monitor any signs of infection, rejection, or other problems. You’ll be required to live close to the transplant center.
Before you leave the hospital, you’ll be given instructions on how to care for your surgical wound. You’ll also be told about any restrictions to follow and be given medication.
Most likely, your medications will include one or more types of immunosuppressant, such as:
- mycophenolate mofetil
- muromonab-CD3 (Orthoclone OKT3)
Immunosuppressants are important after your transplant. They help prevent your body from attacking your new lung. You’ll likely take these medications for the rest of your life.
However, they leave you open to infection and other problems. Make sure to talk to your doctor about all the possible side effects.
You may also be given:
- antifungal medication
- antiviral medication
- anti-ulcer medication
The Mayo Clinic reports that the first year after a transplant is the most critical. This is when the major complications, infection and rejection, are most common. You can minimize these risks by following your lung transplant team’s instructions and immediately reporting any complications.
Although lung transplants are risky, they can have substantial benefits. Depending on your condition, a lung transplant may help you live longer and improve your quality of life.