A lung transplant is a major surgery that’s used to treat severe cases of lung failure. You may need a new lung if you have lung damage related to conditions such as COPD or idiopathic pulmonary fibrosis.
During a lung transplant, a surgeon replaces a diseased or failing lung with a healthy donor lung.
A lung transplant is considered a last resort for treating lung failure. Other treatments and lifestyle changes will almost always be attempted first.
Conditions that may damage your lungs enough to require a transplant include:
- chronic obstructive pulmonary disease (COPD)
- cystic fibrosis
- pulmonary arterial hypertension, a type of high blood pressure that affects the lungs
- pulmonary fibrosis, or lung scarring
- sarcoidosis, which causes the growth of inflammatory cells throughout the organs
According to data from the Organ Procurement & Transplantation Network (OPTN), almost 49,000 lung transplants have been completed in the United States since 1988. Close to 1,500 additional people received a heart-lung transplant during that period. Nearly half of all lung transplants were performed in people ages 50 to 64 years.
Undergoing a lung transplant is no easy task. Receiving a new lung is dependent on many factors, including:
- the availability of a healthy donor lung
- meeting the necessary criteria to undergo surgery
- how risky the surgery is for you personally
Read on to discover the important information you may wish to discuss with a pulmonologist or surgeon.
One of the first things you’ll do to prepare is undergo numerous laboratory and imaging tests.
These tests help determine whether you’re a good fit for a lung transplant and if you’re likely to experience possible risks. They include:
- pulmonary (lung) function tests such as forced vital capacity
- measurement of the levels of oxygen and carbon dioxide in your blood
- tests to measure pulmonary artery pressure and central venous pressure, which are types of blood pressure
- blood glucose tests
- blood tests to rule out cancers and infectious diseases
- cardiac index to assess your heart function
- kidney function tests
- measurement of your body mass index
Once you’ve undergone the necessary tests and met the qualifying criteria, you’ll be placed on a waiting list for a donor lung. Your time on the waiting list will depend on the following factors:
- availability of a matching lung
- the size of the donor lung
- blood type
- geographic distance between you and the donor
- the severity of your condition
- your overall health
You might not qualify for a lung transplant if you have:
- a recent history of cancer, especially within the last 2 to 5 years
- a very recent history of stroke (within the last 30 days)
- chronic diseases of other organs such as the liver or heart
- a condition that weakens your immune system such as HIV
- cognitive impairment
- morbid obesity
A transplant evaluation may also consider your mental health and social support systems. If the lung transplant team concludes that you’re not psychologically prepared for the surgery or don’t have adequate support, you may be disqualified
Both the lengthy evaluation process and the wait for a donor lung may take an emotional toll. For these reasons, you may also undergo emotional and financial counseling. The lung transplant team needs to make sure you’re fully prepared for the aftereffects of the procedure.
A lung transplant is a major surgery and comes with various risks.
Before the surgery, a pulmonologist, a surgeon, or an anesthesiologist should discuss with you whether the potential risks outweigh the benefits. They’ll also advise you on how you can lower your risks.
The major risk of a lung transplant is organ rejection. This happens when your immune system attacks the donor lung as if it were a disease.
Severe rejection could lead to failure of the donated lung. This tends to occur within the first 3 to 6 months.
Possible symptoms include:
Other serious risks can arise from immunosuppressants, the medications you’ll take to help prevent organ rejection.
Immunosuppressants work by lowering your immune response, making it less likely that your body will attack the new foreign lung. Because your body’s “guard” is lowered, immunosuppressants raise your risk of infections such as viral or bacterial pneumonia.
The exact symptoms may vary based on the type of infection. They may include:
Other risks of lung transplant surgery and the medications you take afterward include:
- bleeding and blood clots
- cancer and malignancies because of immunosuppressants, in rare cases
- kidney damage
- gastrointestinal issues
How to lower your risk
To help lower your risks, follow the transplant surgeon and transplant pulmonologist’s instructions before and after your surgery.
Instructions will include making healthy lifestyle choices such as eating a nutrient-rich diet and not smoking. Also, avoid missing any doses of your medications.
The survival rate for people with lung transplants has improved in recent years.
According to the OPTN, the 1-year survival rate for people receiving single lung transplants between 2008 and 2015 was 86.7%. The 5-year survival rate was 47.3%. People receiving double lung transplants had even higher survival rates.
According to the OPTN’s 2020 Annual Data Report, the 1-year survival rate for adults receiving lung transplants in 2019 was
However, survival rates for people receiving lung transplants remain lower than survival rates for people receiving other types of solid organ transplants.
Survival rates may also vary by facility. When researching where to have your surgery, it’s important to ask about the facility’s survival rates.
You may be assigned a lung transplant team to help support your preparation for the transplant. Members may include a transplant pulmonologist, transplant surgeon, and social worker.
Before you’re deemed a candidate for lung transplantation, you must undergo a transplant evaluation. The purpose of the evaluation is to determine whether you qualify for a lung transplant and how likely you’re to survive the operation.
Once you’ve qualified, the lung transplant team will give you complete instructions on the best way to physically prepare for the procedure.
If you’re waiting on a donor lung, it’s good to have your bags packed well in advance. You could receive notice that an organ is available at any time. You may be given a pager by the transplant center, which will go off when it’s time to go to the hospital.
It’s important to keep in mind that, based on data from 2011 to 2014, the wait time may be more than 6 months (depending on your age). In the meantime, you’ll need to visit the transplant center every few months to get reevaluated so you can keep your spot on the waiting list.
As you’re waiting for the transplant, you can also adopt lung-healthy habits such as:
Such habits won’t cure your underlying lung disease, but they can help improve your overall quality of life.
Upcoming changes to lung allocation
In early 2023, the OPTN voted to change its lung allocation policy to one of “continuous distribution.”
Under a continuous distribution policy, all transplant candidates will be assessed simultaneously to determine who has the greatest need. This is in contrast to the current policy, where candidates are placed in more rigid classification systems (based on factors such as location) and have a harder time moving up the waiting list.
These changes are slated to take place on March 2, 2023, with the goal of improving lung transplant access for those who need it most.
When you’re notified that a donor lung is available, you’ll be instructed to report to the transplant facility immediately.
When you and your donor lung arrive at the hospital, you’ll be prepped for surgery.
This includes changing into a hospital gown, receiving an intravenous line, and taking a general anesthetic. The anesthetic 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. They may insert another tube into your nose to 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.
The procedure itself involves the following steps:
- Your surgeon will make a large incision in your chest. They’ll remove your old lung through this incision.
- They’ll connect your new lung to your main airway and blood vessels.
- When your new lung is working properly, the incision will be closed.
- You’ll be moved to an intensive care unit (ICU) to recover.
The procedure can take between 6 and 8 hours. The length of your surgery will depend on factors such as whether you receive a single lung transplant or a double lung transplant.
It takes about 3 to 6 months to fully recover from a lung transplant. You may need to wait a couple of months before you return to work and other regular activities.
You can expect to remain in the ICU for a few days after the procedure. Your surgeon will need to closely monitor your vital signs.
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.
It can take 10 to 14 days before you’re discharged from the hospital. 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 few months, you’ll have regular appointments with a lung transplant team. They’ll monitor any signs of infection, rejection, or other issues. You’ll be required to live close to the transplant center.
Before you leave the hospital, you’ll receive instructions on how to care for your surgical wound. You’ll also receive medication and be advised about any restrictions to follow.
Most likely, your medications will include one or more types of immunosuppressants. These help to prevent organ rejection.
You’ll likely take immunosuppressants for the rest of your life. Examples include:
- azathioprine (Azasan, Imuran)
- basiliximab (Simulect)
- cyclosporine (Gengraf, Neoral, Sandimmune)
- muromonab-CD3 (Orthoclone OKT3)
- mycophenolate mofetil (CellCept)
- tacrolimus (Prograf)
Immunosuppressants help prevent your body from attacking your new lung. They also leave you vulnerable to infection and other issues. Make sure to talk with a primary care physician or transplant surgeon about all possible side effects.
Some of the immunosuppressants listed above are intended to treat conditions unrelated to lung transplant such as organ rejection after a kidney transplant. A healthcare professional may still prescribe them to you. This is known as off-label drug use.
OFF-LABEL DRUG USE
Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat people. So, a doctor can prescribe a drug however they think is best for your care.
You may also be given:
The major risks of surgery are infection and organ rejection. They’re most common in the first year after your surgery, according to sources such as a 2018 study and the National Health Service. Organ rejection may occur within the first 3 months.
You can minimize these risks by following a lung transplant team’s instructions and immediately reporting any concerns or issues.
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.