Lung transplant

A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. Depending on your medical condition, a lung transplant may involve replacing one of your lungs (single-lung transplant) or both of them (double-lung transplant). In some situations, the lungs may be transplanted along with a donor heart (heart-lung transplant).

Living-donor lung transplants are rare, but possible. These lung transplants require at least two donors because each person can only donate a portion (lobe) of a lung. The lobes donated depend on the sections of your lungs that need to be replaced. Because the procedure is still new, living-donor lung transplants are usually reserved for people who are in urgent need of a transplant and who are unlikely to survive until a deceased donor lung is available.

Why it's done

All the cells in your body need oxygen. When your cells use oxygen, they produce carbon dioxide. Too much carbon dioxide can be harmful to your body, so it has to be removed quickly. Your lungs do the work of taking in oxygen when you inhale and eliminating carbon dioxide when you exhale.

Unhealthy or damaged lungs can make it difficult for your body to exchange oxygen and carbon dioxide. A variety of diseases and conditions can damage your lungs and hinder their ability to function effectively, including:

• Chronic obstructive pulmonary disease (COPD), including emphysema
• Scarring of the lungs (pulmonary fibrosis)
• Cystic fibrosis
• Sarcoidosis with advanced fibrosis
• Pulmonary hypertension
• Damage to lung arteries caused by an untreated congenital heart defect (Eisenmenger syndrome)

In some cases, lung damage can be treated with medication or with special breathing devices. But, if your lung function deteriorates to the point that these or other therapies no longer help improve breathing, or when poor lung function is life-threatening, a lung transplant may be an appropriate treatment option. A lung transplant may be able to increase your life expectancy and substantially improve your quality of life.

Risks

A lung transplant poses many risks of complications, some potentially fatal. The two major risks are rejection and infection.

• Rejection. Your immune system defends your body against foreign substances. Even with the best possible match between you and the donor, your immune system will try to attack and reject your new lung or lungs. Your drug regimen after transplant will include medications to suppress your immune system (immunosuppressive agents) in an effort to prevent organ rejection. You'll likely take these drugs for the rest of your life.

  Some immunosuppressive agents may cause noticeable side effects. Your face may become round and full. You may gain weight, develop acne or facial hair, or experience stomach problems. These effects may decrease as time goes on. Some immune system medications can also increase your risk of developing new or aggravating existing conditions, such as high blood pressure, high cholesterol and cancer.

• Infection. The medications to suppress your immune system make your body more vulnerable to infection. The lungs are the most common site of post-transplant infections, and infection is the leading cause of complications and death after lung transplant. To help prevent infection, your doctor may prescribe antibacterial, antiviral and antifungal medications. Your health care team may also help you learn breathing exercises to help prevent pneumonia and other infections.

Contact your doctor if you experience any of the following signs or symptoms of organ rejection or lung infection after your transplant.

Signs and symptoms of rejection include:

• Fatigue
• Weakness
• Fever
• Shortness of breath

Signs and symptoms of lung infection include:

• A fever above 100.4 F (38 C)
• Shortness of breath
• Cough

How you prepare

According to the Scientific Registry of Transplant Recipients, about 2,500 people in the U.S. are waiting to receive a lung transplant on any given day — but there are only enough donor organs to provide about 1,500 lung transplants a year.

When a donor organ becomes available, the donor-recipient matching system administered by the United Network for Organ Sharing (UNOS) finds an appropriate match based on specific criteria, including:

• Blood type
• Geographic distance between donor organ and transplant recipient
• Lung allocation score

Your lung allocation score is determined by the type and severity of lung disease and the likelihood of a transplant being successful — not the amount of time spent on the waiting list. The only exception is for children younger than age 12. Pediatric candidates receive donor lungs based on the amount of time they've been on the waiting list, blood type and distance to the donor hospital. Contrary to what you might interpret from the media, celebrities and wealthy people do not move up the list because of who they are.

When you're on the waiting list for a lung transplant, it may be a few months to several years until a suitable donor becomes available. During that time, your lung disease may continue to progress. You need to continue to treat and manage it as you wait. If your overall health deteriorates while you are waiting for a transplant, it's possible that transplantation may no longer be a suitable treatment for your condition.

In addition to managing your existing lung disease, while you wait for a donor lung, you should also:

• Take your medications as prescribed.
• Follow your diet and exercise guidelines.
• Keep all appointments with your health care team.
• Avoid crowds and people with a respiratory infection.
• Stay involved in healthy activities, including relaxing and spending time with family and friends.
• Keep a positive outlook.
• Consider joining a support group.

A donated lung remains viable only for four to six hours after it's removed from the donor, so be prepared to act quickly. Make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy — including an extra 24-hour supply of your medications — and arrange transportation to the transplant center in advance. When a donated lung becomes available, you may be expected to arrive at the hospital within about two to three hours.

What you can expect

During your lung transplant

When you arrive at the hospital, you will have a brief examination, which may include blood tests, urine samples and a chest X-ray.

You will be taken to an operating room area while waiting for final assessment of the donor lung. If the donor lung is unacceptable, the transplant will be canceled. If the donor lung is acceptable, the transplant team will inform you and your family, and the transplant will proceed as planned.

A lung transplant may take from four to 12 hours, depending on the specific procedure.

In a single-lung transplant, the surgeon makes an incision on the side of your chest and removes the diseased lung. The main blood vessels to and from the new lung and the main airway of the new lung are sewn to your main blood vessels and airway. Sometimes a heart-lung machine is used to regulate blood flow and oxygen supply during the procedure. The incision for a double-lung transplant is made across the middle of the chest. The process is similar to that of the single-lung transplant, but the surgeon will do the entire procedure on one lung before repeating it on the other.

If you're receiving a heart-lung transplant, you'll be hooked up to a heart-lung machine. The diseased organs are removed, except for a small portion of the heart to which the new heart will be sewn. The new organs are transplanted as a whole system — the donor heart and lungs aren't separated from each other. The airways of the new lungs are attached to your main airway, and the main blood vessel (aorta) of the new heart is attached to your aorta.

After your lung transplant

After the surgery you'll have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. Expect soreness or pain around the incision site while you're healing. Recovery often involves a one- to three-week hospital stay.

After you're discharged from the hospital, you'll require about three months of frequent monitoring by the lung transplant team to prevent, detect and treat complications and to assess your lung function. During this time, you'll need to stay close to the transplant center. Your follow-up visits may involve laboratory tests, chest X-rays, an electrocardiogram (ECG), and checkups with a transplant pulmonologist.

After your transplant, living a healthy lifestyle is key to sustaining your new lung. Smoking isn't allowed, and the use of alcohol is strictly limited. Following a nutritious diet also can help you stay healthy post-transplant.

Exercise is an extremely important part of rehabilitation after your lung transplant. A regular schedule of moderate exercise will help you make the most of your new lung by increasing your endurance, strength, energy level and the ability to do physical activity. Your health care team will work with you to design an exercise program that's right for you.

Results

A lung transplant can substantially improve your quality of life. The first year after the transplant — when surgical complications, rejection and infection pose the greatest threats — is the most critical period.

Organ rejection after transplant is possible, and sometimes the underlying cause of lung disease damages the new lung. If your new lung fails, subsequent treatment options may be limited. The survival rate for single-lung transplants is more than 82 percent at one year, nearly 60 percent at three years, and more than 43 percent at five years, according to the Organ Procurement and Transplantation Network. The survival rate for double-lung transplants is similar — 82 percent at one year, 63 percent at three years, and 48 percent at five years.

Source:www.mayoclinic.com