Lung Transplant

Definition

A lung transplant is a surgical procedure to remove severely diseased lungs and replace them with healthy lungs from a human donor. One or both lungs may be transplanted. In some cases, a heart transplant is done simultaneously, in which case the procedure is called a heart-lung transplant. This article will only cover lung transplants.

Parts of the Body Involved

The transplant involves the lungs and the chest.

Reasons for Procedure

A lung transplant is done to treat irreversible, life-threatening lung disease, such as:

Normal vs. Emphysemic Lung

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Risk Factors for Complications During the Procedure

People whose lung function has been deteriorating for a long period of time are at the highest risk of developing complications from lung transplantation.

What to Expect

Prior to Procedure

Before you have a lung transplant, you will go through an intensive evaluation to determine if you are a good candidate for this surgery. During the evaluation, which often requires a hospital stay, you will have some or all of the following tests:

  • Physical exam
  • Blood tests
  • Tissue typing
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest CT scan—a type of x-ray that uses a computer to make pictures of the inside of the lungs
  • Echocardiogram—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
  • Pulmonary function tests—tests that measure the function of the lungs
  • Ventilation-perfusion lung scan—a test that examines the movement of blood and air through the lungs
  • Cardiac catheterization—a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply

If you are accepted as a candidate for lung transplant, you will be put on a waiting list. Donors are matched carefully for size, tissue type, and other factors. In some cases, healthy family members have donated one of their lungs if only a single transplant is contemplated.

Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor organ becomes available.

In the days leading up to your procedure:

  • Arrange for a ride to and from the hospital
  • Arrange for help at home after returning from the hospital
  • Take medications as directed and do not take over-the-counter medications without checking with your doctor
  • The night before, have a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor

During Procedure

IV fluids, oxygen, anesthesia, will be delivered to you. You will be placed on a ventilator and your blood circulation will be diverted through a heart-lung machine.

Anesthesia

General anesthesia will be administered for the surgery.

Description of the Procedure

For a single lung transplant, the surgeon makes an incision on your side, about six inches below your underarm. A horizontal incision across the lower chest is made for a double lung transplant. You will be put on a ventilator and a heart-lung machine. The heart-lung machine takes over the functions of the heart and lungs during the operation, the ventilator maintains your breathing. A small section of rib is permanently removed to allow access to your lung. The old lung is cut away from the main blood vessel and bronchus (large airway), and the new lung is inserted. The blood vessels and bronchus are attached to the new lung.

After Procedure

You will stay in the intensive care unit for 2 to 3 days for monitoring.

How Long Will It Take?

The surgery is 6 to 12 hours for a double lung transplant and 4 to 8 hours for a single lung transplant.

Will It Hurt?

Anesthesia prevents pain during the procedure. You'll likely experience pain while recovering but will receive drugs to relieve the discomfort.

Possible Complications

  • Infection
  • Rejection of the donor lung
  • Pneumonia
  • Excessive bleeding
  • Anesthesia-related problems
  • Cancer related to taking immunosuppressant medications
  • Death

Average Hospital Stay

The hospital stay is typically 7 to 10 days, if there are no signs of rejecting the new lung.

Postoperative Care

For the rest of your life, do the following to maintain the health of your new lung or lungs:

  • Take immunosuppressive drugs and other medications as directed by your doctor. These drugs will help to prevent your body from rejecting the new lung. Only take drugs approved by your doctor.
  • Have regular lung biopsies. A sample (biopsy) of lung tissue will be taken at regular intervals, every 3 months the first year, twice a year the second year, and annually in subsequent years, to check for lung rejection.
  • Have regular blood work. You will have periodic blood testing for the rest of your life.
  • Clinical evaluation. You will need to measure your temperature, weight, and blood pressure levels regularly.
  • Lifestyle changes are also essential to help maintain your health after surgery. These include:
    • Avoiding exposure to tobacco smoke and other toxic elements
    • Possibly limiting your intake of:
      • Salt
      • Foods high in fat and cholesterol
      • Concentrated sweets
      • Alcohol
      • Getting regular exercise, to help maintain lung capacity

Outcome

It takes about six months to recover from this surgery. Over 60% of lung transplant patients survive three years or more after transplantation.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills; you are more susceptible to infections while taking immunosuppressive medications
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Increased sputum (phlegm) production
  • Coughing up blood
  • The surgical incision opens
  • Changes in your weight or blood pressure
  • New chest pain
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine

RESOURCES:

American Lung Association
http://www.lungusa.org

United Network for Organ Sharing
http://www.transplantliving.org

CANADIAN RESOURCES:

Canadian Lung Association
http://www.lung.ca/

Toronto General Hospital
http://www.torontotransplant.org/

References:

Duke University Medical Center, Transplant Center website. Available at: http://organtransplant.mc.duke.edu/transplant.html . Accessed October 14, 2005.

Medical encyclopedia: lung transplant. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003010.htm . Accessed October 14, 2005.



Last reviewed November 2007 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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