What Is a Lung Transplant?
A lung transplant is surgery to remove a person's
diseased lung and replace it with a healthy lung from a deceased donor.
Lung transplants are done on people who are likely
to die from lung disease within 1 to 2 years. Their conditions are so severe
that other treatments, such as medicines or breathing devices, no longer
work.
Overview
Lung transplants aren't very common due to the small
number of donor organs available. Slightly more than 1,400 lung transplants
were done in 2007. More donor lungs would mean a larger number of suitable
lungs available for transplant.
Lung transplants most often are done in people aged
18 to 65. Sometimes this surgery is done in children and older adults. This
article focuses on lung transplants in adults.
Each patient must go through a careful screening
process to make sure he or she is a good candidate for a lung transplant. Donor
lungs also are carefully screened to make sure they're healthy enough to be
used in a transplant.
The Organ Procurement and Transplantation Network
(OPTN) manages the nationwide organ-sharing process. OPTN also maintains the
waiting lists for all organ donations.
The number of people on the lung transplant waiting
list constantly changes. About half of the people on the list receive a lung in
any given year.
Some people get one lung during a transplant. This
is called a single-lung transplant. Other people get two lungs. This is called
a double-lung transplant.
Some people who have severe heart disease and lung
disease get a heart and lung(s). This is called a heartlung
transplant.
A rare kind of lung transplant is a living donor
lobar lung transplant. In this operation, a healthy adult donates a segment, or
lobe, of one lung to another person. This type of transplant usually is done in
children.
Outlook
Lung transplants are a "last resort" treatment for
people who have severe disease and no other medical options.
A lung transplant can improve a person's quality of
life. For people who have certain lung problems, a transplant also may help
them live longer than they would without the surgery.
Lung transplants have serious risks. Your body may
reject the new lung, or you may develop infections. The short- and long-term
complications of a lung transplant can be life threatening.
Other Names for Lung Transplant
- Single-lung transplant
- Double-lung transplant
Who Needs a Lung Transplant?
Your doctor may recommend a lung transplant if you
have severe lung disease that's getting worse. If your condition is so serious
that other treatments don't work, lung transplant may be the only option.
Lung transplants most often are used to treat people
who have severe:
Applying to a Lung Transplant Program
Lung transplants are done in medical centers (large
hospitals) where the staff has a lot of organ transplant experience. If you
need a lung transplant, you must apply to a center's transplant program.
Transplant teams at the medical center manage all
aspects of the center's transplant program. Transplant team members may include
a:
- Thoracic (THOR-as-ik) surgeon. This is a doctor
who performs lung and chest surgery.
- Pulmonologist. This is a doctor who specializes
in lung diseases and conditions.
- Cardiologist. This is a doctor who specializes in
heart diseases and conditions.
- Respiratory technician. This is a person who
cares for people who have breathing and lung problems.
- Transplant coordinator. This is a person who
arranges the surgery.
Other team members may include a social worker,
psychiatrist, financial coordinator, and other specialists and medical
personnel, such as a nutritionist and nurses.
The transplant team will need to find out whether
you're a candidate for lung transplant. They will want to make sure you're
healthy enough to have the surgery and go through a recovery program
afterward.
To do this, they will ask about your medical
history. The team will want to know whether you have other serious illnesses or
conditions, such as cancer, HIV, or hepatitis. They also will ask whether
you've had a major chest surgery before. A previous chest surgery may make it
hard to do a lung transplant.
The team also will want to know whether you smoke or
use alcohol or drugs.
You also will have tests to determine whether you're
healthy enough for a lung transplant. Tests may include:
- Lung
function tests. These tests measure the size of your lungs, how much air
you can breathe in and out, how fast you can breathe air out, and how well your
lungs deliver oxygen to your blood.
- Blood
tests. Blood tests help doctors check for certain diseases and conditions.
They also help check the function of your organs and show how well treatments
are working.
- Chest
CT scan. This test creates precise pictures of the structures inside your
chest, such as your lungs.
- EKG
(electrocardiogram). This test detects and records the heart's electrical
activity.
- Echocardiogram.
This test uses sound waves to create pictures of your heart.
- Right
cardiac catheterization. This test measures blood pressure in the right
side of your heart. The results give clues about
heart
valve disease,
heart
failure, or lung problems.
You'll talk with team members to make sure you're
mentally and emotionally willing to accept the risks of the transplant process
and later treatment. The team may ask whether you have a good support network
of family and friends.
What To Expect Before a Lung Transplant
If you're accepted into a medical center's
transplant program, you'll be placed on the Organ Procurement and
Transplantation Network's (OPTN's) national waiting list. Your transplant team
will work with you to make sure you're ready for the transplant if a donor lung
becomes available.
Waiting for a donor lung can be frustrating.
However, you can do several things to prepare.
- Go to all of your medical appointments with the
transplant team. Take all of your medicines as prescribed.
- Stay as healthy as possible. Don't smoke, and
follow your doctor's advice on breathing exercises, physical activity, diet,
and drinking alcohol.
- Talk regularly with your transplant team. You and
your family should know what to do if a donor lung becomes available. You also
should know what to expect before, during, and after the transplant.
- Be ready to go to the transplant center right
away if a donor lung becomes available. Make sure the transplant center knows
how to reach you at any time, day or night. Your transplant team may give you a
pager so they can reach you right away. Make travel and lodging plans in
advance. Have a packed suitcase ready to go.
While you wait for a lung, you may feel worried,
scared, anxious, or depressed. These feelings are normal in this situation.
Talk to your health care team about how you feel. They can offer suggestions
for coping with your emotions. Family and friends also can offer support.
When a Donor Lung Becomes Available
OPTN matches a donor's lungs to a recipient based on
need. OPTN will consider how severe a person's disease is and how quickly it's
worsening. OPTN also will consider whether the transplant will improve the
recipient's chances of survival, and by how much.
Organs are matched for blood type and the size of
the donor lung and the recipient.
If OPTN and your transplant center think they have a
good match for you, the center will call you and ask you to come in as soon as
possible.
Once you arrive, your team will do tests to make
sure you're healthy enough to have the surgery and that the lung is a good
match. If you're healthy enough and the lung is a good match, the team will
prepare you for surgery.
What To Expect During a Lung Transplant
Just before the surgery, you will get general
anesthesia (AN-es-THE-ze-a). The term "anesthesia" refers to a loss of feeling
and awareness. With general anesthesia, you will be asleep during the surgery
and not feel any pain.
Once you're asleep, your doctors will make a small
incision (cut) in your chest, and insert a central venous catheter into a vein.
This tube allows easy access to your bloodstream. Doctors use it to deliver
fluids and medicines to your body.
Your doctors also will insert a tube in your mouth
and down your windpipe to help you breathe. They also will insert a tube in
your nose and down to your stomach to drain contents from your stomach. A
catheter will be used to keep your bladder empty.
The surgeon will make a cut in your chest to open
it. He or she will then cut the main airway to your diseased lung and the blood
vessels connecting your lung to your heart.
The surgeon will remove your diseased lung and place
the donor organ in your chest. Then the surgeon will connect the main airway of
the donor lung to your airway and its blood vessels to those of your heart.
If you're having a double-lung transplant, you may
be connected to a heart-lung bypass machine. This machine takes over for your
heart and pumps oxygen-rich blood to your body. During the surgery, the surgeon
will remove your diseased lungs, one at a time, and replace them with the donor
lungs.
A single-lung transplant usually takes 4 to 8 hours.
A double-lung transplant usually takes 6 to 12 hours.
Some people may need a heartlung transplant. A
heartlung transplant is surgery in which both the heart and lung(s) are
replaced with healthy organs from a deceased donor. For this surgery, you're
connected to a heart-lung bypass machine.
What To Expect After a Lung Transplant
Recovery in the Hospital
After surgery, you'll go to the hospital's intensive
care unit (ICU) for at least several days. The tubes that were inserted before
surgery will remain for a few days.
The tube in your windpipe helps you breathe. Other
tubes deliver medicines to, and drain fluids from, your body. You also will
have sticky patches called electrodes attached to your chest to monitor your
heart.
After leaving the ICU, you'll go to a hospital room.
The staff will carefully watch your recovery.
You'll be taught how to do deep breathing exercises
with a spirometer (spi-ROM-eh-ter). This is a machine with a tube that you
breathe into. When you breathe into the tube, the spirometer measures how much
air your lungs can hold. It also measures how fast you can blow air out of your
lungs after taking a deep breath.
You'll need to cough often. Coughing helps clear
fluids from your lungs so they can work properly. A nurse will show you how to
hold a pillow tightly near your incision area while you cough to help decrease
discomfort.
Your immune system will regard your new lung as a
"foreign object." It will create antibodies (proteins) against the lung. This
may cause your body to reject the new organ. To prevent this, your doctor will
prescribe medicines to suppress your immune system. These medicines are called
immunosuppressants.
Because these medicines weaken your immune system,
you're more likely to get an infection after the transplant. Your medical team
will take steps to prevent infection while you're in the hospital.
On average, people who have a lung transplant stay
in the hospital from 1 to 3 weeks. However, some people have complications and
stay much longer.
Recovery After Leaving the Hospital
Before you leave the hospital, your medical team
will teach you how to keep track of your overall health. You'll learn how to
watch your weight and take your blood pressure, pulse, and temperature.
Staff also will show you how to check your lung
function. If you have diabetes, you'll learn how to test your blood sugar.
You'll also learn the signs of the two main
complications of lung transplant surgery: rejection and infection. (For more
information, see "What Are the Risks of Lung
Transplant?")
For the first 3 months after surgery, you'll go to
the hospital often for
blood
tests,
chest
x rays,
lung
function tests, and other tests. After 3 months, if you're doing well,
you'll visit less often.
Making healthy lifestyle choices is very important.
Not smoking, following a healthy diet, and following your doctor's advice on
using alcohol will help you recover and stay as healthy as possible.
A healthy diet includes a variety of fruits,
vegetables, and whole grains. It also includes lean meats, poultry, fish,
beans, and fat-free or low-fat milk or milk products. A healthy diet is low in
saturated fat, trans fat, cholesterol, sodium (salt), and added
sugar.
For more information on following a healthy diet,
see the National Heart, Lung, and Blood Institute's
Aim for a
Healthy Weight Web site,
"Your
Guide to a Healthy Heart," and
"Your
Guide to Lowering Your Blood Pressure With DASH." All of these resources
include general information about healthy eating.
Your doctor may recommend an exercise program when
you're able to do physical activity.
Emotional Issues
Having a lung transplant may cause fear, anxiety,
and stress. While you're waiting for a lung transplant, you may worry that you
won't live long enough to get a new lung. After surgery, you may feel
overwhelmed, depressed, or worried about complications.
All of these feelings are normal for someone going
through major surgery. It's important to talk about how you feel with your
health care team. Talking to a professional counselor also can help. If you're
feeling very depressed, your health care team or counselor may prescribe
medicines to make you feel better.
Support from family and friends also can help
relieve stress and anxiety. Let your loved ones know how you feel and what they
can do to help you.
What Are the Risks of Lung Transplant?
A lung transplant can improve your quality of life
and extend your lifespan. The first year after the transplant is the most
critical. This is when the risk for complications is the highest.
In recent years, short-term survival from lung
transplant has improved. Figures from 2005 on single-lung transplant show
that:
- More than 82 percent of patients survive the
first year
- Nearly 60 percent survive 3 years
- More than 43 percent survive 5 years
Survival rates for double-lung transplants are
similar. Talk with your doctor about what these figures may mean for you.
Complications
The major complications of lung transplant are
rejection and infection.
Rejection
Your immune system will regard your new lung as a
"foreign object." It will create antibodies (proteins) against the lung. This
may cause your body to reject the new organ.
To prevent this, your doctor will prescribe
medicines called immunosuppressants to suppress your immune system. You will
need to take these medicines for the rest of your life.
Rejection is most common in the first 6 months after
surgery, but it can happen any time after the transplant. Rejection can develop
slowly or suddenly. Your doctor will teach you how to recognize possible signs
and symptoms of rejection. If you know these signs and symptoms, you can seek
treatment right away.
Signs and symptoms of rejection include:
- Fever and flu-like symptoms
- Chest congestion
- Cough
- Shortness of breath
- New pain around the lung
- Generally feeling unwell
If you have any of these signs or symptoms, seek
medical care. Your doctor may prescribe medicines to treat the rejection and
prevent complications.
These medicines may cause side effects, such as
headaches, nausea (feeling sick to your stomach), and flu-like symptoms. If you
have side effects, talk to your doctors. They may be able to change your
medicine or adjust the doses.
Infection
The medicines you take to prevent the rejection of
your new lung may weaken your immune system. As a result, you're more likely to
get infections.
While you're in the hospital, staff will take
special steps to prevent you from getting infections. After you leave the
hospital, you also can take steps to prevent infection:
- Wash your hands often.
- Take care of your teeth and gums.
- Protect your skin from scratches and sores.
- Stay away from crowds and from people who have
colds and the flu.
Other Risks
Long-term use of immunosuppressants can cause
diabetes, kidney damage, and osteoporosis (thinning of the bones). These
medicines also can increase the risk of cancer. Talk to your doctor about the
long-term risks of using immunosuppressants.
Key Points
- Lung transplant is surgery to remove a person's
diseased lung and replace it with a healthy lung from a deceased donor.
- Lung transplants are done on people who are
likely to die from lung disease within 1 to 2 years. Their conditions are so
severe that other treatments, such as medicines or breathing devices, no longer
work.
- Lung transplants aren't very common due to the
small number of donor lungs available. Each patient must go through a careful
screening process to make sure he or she is a good candidate for a lung
transplant.
- Some people get one lung during a transplant.
This is called a single-lung transplant. Other people get two lungs. This is
called a double-lung transplant. Some people who have severe heart disease and
lung disease get both organs. This is called a heartlung transplant.
- Lung transplants most often are used to treat
people who have severe
COPD
(chronic obstructive pulmonary disease),
cystic
fibrosis,
idiopathic
pulmonary fibrosis,
pulmonary
hypertension, or
alpha-1
antitrypsin deficiency.
- Lung transplants are done in medical centers
(large hospitals) where the staff has a lot of organ transplant experience. If
you need a lung transplant, you must apply to a center's transplant program.
You will go through a careful selection process.
- If you're accepted into a medical center's
transplant program, you'll be placed on the Organ Procurement and
Transplantation Network's (OPTN's) national waiting list. OPTN matches a
donor's lungs to a recipient based on need, severity of disease, and whether
the transplant will improve the recipient's chances of survival. Organs are
matched for blood type and the size of the donor lung and the recipient.
- During the lung transplant, the surgeon will make
a cut in your chest to open it. He or she will remove your diseased lung and
connect the main airway of the donor lung to your airway and its blood vessels
to those of your heart. For a double-lung transplant, the surgeon will remove
your diseased lungs, one at a time, and replace them with the donor lungs. You
may be placed on a heart-lung bypass machine during the surgery.
- After surgery, you'll spend several days in the
hospital's intensive care unit. Then you will go to a hospital room. The staff
will carefully watch your recovery. On average, people spend 1 to 3 weeks in
the hospital.
- Before you leave the hospital, the staff will
teach you how to keep track of your overall health, how to check your lung
function, and how to make healthy lifestyle choices. You also will learn the
signs of the two main complications of lung transplantrejection and
infection.
- Rejection can come on suddenly or slowly. To
prevent rejection, your doctor will prescribe medicines to suppress your immune
system. You will need to take these medicines for the rest of your life.
- The medicines you take to prevent rejection may
weaken your immune system. As a result, you're more likely to get infections.
You can take steps to prevent infection. Wash your hands often, take care of
your teeth and gums, protect your skin from scratches and sores, and stay away
from crowds and people who have colds or the flu.
- A lung transplant can improve your quality of
life and may help you live longer than you would without the surgery. However,
lung transplants have serious risks. The short- and long-term complications of
the surgery can be life threatening.
Links to Other Information About Lung
Transplant
Non-NHLBI Resources
Clinical Trials
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