Lung Transplant

Alternate Names
pulmonary transplant
transplantation of the lungs



Definition of Lung Transplant

In lung transplantation, a healthy donor lung is removed from a person who is brain dead and implanted into a person with lung disease who needs a healthy lung. Sometimes one lung is transplanted and sometimes a person is in need of a double lung transplant.

Who is a candidate for the procedure?

Lung transplantation is only offered to persons who have severe enough failure of their lungs as to interfere with normal activities. These are people who doctors estimate will not live longer than 1 to 2 years unless they receive a replacement lung.

The most common conditions resulting in this degree of lung failure include:

• emphysema, a chronic lung disease most often caused by smoking
• pulmonary fibrosis, a respiratory disease caused by inhaling asbestos fibers
• cystic fibrosis, an inherited disease that affects the respiratory and digestive systems
• alpha-1-antitrypsin deficiency, a deficiency of a protein produced in the liver that is associated with emphysema and liver disease
• pulmonary hypertension, a condition in which pressure in the blood vessels of the lungs increases. This increased pressure causes damage to the blood vessels and heart.

A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a lung transplant. This team includes surgeons, lung specialists known as pulmonologists, social workers, nurses, and transplant coordinators.

A few conditions would disqualify a person from receiving a lung transplant. These include:

• cancer within the past five years
• certain infections, such as tuberculosis or osteomyelitis, a bone infection
• severe lung, liver, or kidney disease that would make the operation too risky

A candidate for a lung transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new lung because it is something foreign. .

Immunosuppressants are medications that keep the immune system from attacking the new lung. These medications need to be taken for as long as the new lung functions.

The person will also need lifelong follow-up with healthcare professionals. If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a lung from a donor.

How is the procedure performed?

Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain-dead donor, sometimes by two or three teams operating at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.

Usually, both lungs are taken out together. If a double lung transplant is to be done, the double lung will be transplanted together. If two single lung transplants are needed, that is, for two separate recipients, the lungs can be separated after they are removed from the donor. The lungs can be preserved safely for only about 5 to 6 hours. The transplant surgery needs to take place within this timeframe.

The recipient is given general anesthesia. This means that the person is put to sleep with medications, is not aware of the operation and feels no pain. The person is put on a ventilator, or artificial breathing machine, during first part of the surgery, but once the chest is open and the surgeons are ready to replace the damaged lung, the ventilator is shut off, the lungs are deflated, the heart is stopped, and the person is put on a heart-lung bypass machine to keep the blood oxygenated and flowing at the correct pressure during the operation.

The operation is carried out in three stages:

• The diseased lung is cut away from its main blood vessel attachments to the heart and to the large airway, known as a bronchus.
• The new healthy lung is put in place. The blood vessels and bronchus are connected to the new lung.
• Blood flow and airflow are restored to the new lung. The heart is restarted with an electric pulse, the ventilator is reconnected, and the surgeon checks carefully to see if there is any bleeding and if the lung is filling normally with air.

If the new lung is working properly, the incision is closed. The recipient is then taken to the intensive care unit for recovery. A double lung transplant is done much like two single lung transplants. The surgeon starts with the more diseased lung, removes it, implants the new one, and then moves on to the less diseased side.

What happens right after the procedure?

The transplant recipient will usually be in the hospital for 7 to 10 days. The person may stay on the ventilator overnight to help with breathing. If the person is stable and the donor lung is functioning normally, the breathing machine is sometimes removed at the end of the surgery.

The recipient is usually well enough to move out of the intensive care unit after 2 to 3 days. Immunosuppressant medications are given right before or during the surgery. Blood tests will be done in the first few weeks after transplantation to be sure that the correct dosage of the medications are being given. The recipient must continue to take these medications for the rest of his or her life.

Before leaving the hospital, the person will be given instructions including

• how to care for the transplant
• how to take the medications
• what side effects to expect
• how to take care of the surgical scar
• early signs and symptoms of rejection
• physical activity and rehabilitation
• breathing exercises to prevent pneumonia

What happens later at home?

At home, the recipient can expect a slow but steady recovery. Walking is encouraged to help prevent pneumonia and other lung complications. Walking also helps the person to regain strength. Heavy lifting and straining should be avoided for several weeks. Driving is permitted once the incision heals.

What are the potential complications after the procedure?

There are several complications that can affect a recipient of a lung transplant. Some of these can occur right after the surgery and others can occur at any time for the rest of the person's life.

Complications include:

• infection. A person who takes immunosuppressant medications is more vulnerable to infection. Some infections are minor but others can be life threatening. This is especially true for infections that affect the lungs directly.
• major bleeding. This is rare, but in some cases, there is a lot of scarring on the lung and other nearby tissue. These areas may bleed. Sometimes a second operation is needed to remove any blood clots and control the bleeding.
• rejection. The body's normal response to a transplanted organ is to reject it. Even though they take medications to prevent rejection, most recipients will have one or more episodes of rejection. These are treated by increasing the dose of the medication or switching to a different medication.
• cancer. This is another possible long-term consequence of problem of immunosuppressant medications, because they interfere with immune cells that usually kill malignant cells before they can develop into tumors. The most common cancers that develop in this circumstance are skin cancer and lymphoma, a cancer of the white blood cells.