Lung Transplant Program
Lung Transplant Education
Your success as a lung transplant recipient depends in part on your understanding of what to expect before, during, and after your transplant surgery.
Reasons You Might Need a Lung Transplant
People need lung transplants when their lungs can no longer perform their vital function of exchanging oxygen and carbon dioxide. Lung transplant candidates have end-stage lung disease and are expected to live less than two years. They often require continuous oxygen and are extremely fatigued from the lack of oxygen. Their lungs are too diseased to be managed medically, and no other kind of surgery will help them.
Several different diseases can lead to end-stage lung failure:
- Chronic obstructive pulmonary disease (COPD) can be caused by asthma, chronic bronchitis or emphysema. Over time, individuals with COPD slowly lose their ability to breathe.
- Alpha-1 antitrypsin deficiency is a hereditary condition in which a lack of alpha-1 antitrypsin
- Interstitial Lung Disease (ILD) is a general term that includes a variety of chronic lung disorders such as idiopathic pulmonary fibrosis and sarcoidosis.
- Bronchiectasis is the irreversible widening of the airways. As airways widen, they become less rigid and more prone to collapse. It also becomes more difficult to clear away secretions.
- Cystic fibrosis is a genetic disease that is recessively inherited, meaning both parents need to have the defective gene.
At Emory, we consider lung transplantation when conventional medication or surgery cannot improve the function of your failing lungs. Lung transplantation offers many people the chance not only to survive but to return to a more normal, productive lifestyle. It is important to understand that a lung transplant does not "cure" your lung disease. You will need daily medication and rigorous follow-up by the transplant team for the rest of your life.
Waiting for a Lung Transplant
Once the transplant team agrees that the patient is a suitable lung transplant candidate, the team will place the candidate. Due to a critical shortage of donor organs, adults can wait up to two years or more before a suitable donor lung is available. Often patients can wait at home during this time.
Status on the List
A candidate will be listed as an active status patient on the lung transplant waiting list. When an organ becomes available, it is matched with a recipient based on blood type, body size and lung allocation score.
OPTN policy does allow multiple listings. Multiple listings involve registering at two or more transplant centers in different local areas. If you are considering multiple listing, discuss this with your transplant team to find out how they handle such requests.
Finding a Donor
Every effort will be made to find a donor quickly. The wait for a donor depends on multiple factors including the candidate.
The United Network for Organ Sharing (UNOS) provides a toll-free patient services line to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. You may also call this number to discuss problems with your transplant center or the transplantation system in general. The toll-free patient services number is 1-888-894-6361.
Anxiety While Waiting is Normal
Helpful ways of coping with the stress of waiting for a lung may include:
- Keeping up your normal daily routines as much as possible.
- Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
- Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation.
Lung Transplant Surgery
When a compatible donor lung is found, you will be notified by a member of the transplant team. At that time, you will be given instructions about coming to the hospital for your transplant.
Once you have been checked in at the hospital, you will be taken to the operating room. There, you will receive general anesthesia and be put to sleep. You may be placed on a heart-lung machine (cardiopulmonary bypass) that will handle the functions of your heart and lungs while the surgeon is working on both your old and new lungs. You will also have a breathing tube in your throat, called an endotracheal tube. This tube is connected to a machine called a ventilator, which will breathe for you during and after the operation.
Single Lung Transplant
If the recipient is having a single lung transplant, he/she will have a thoracotomy incision either on their right or their left side, depending on which lung is being replaced. After the donor lung arrives in the operating room, the surgeon will remove the diseased lung. The recipient will be ventilated using the other lung. If the remaining lung is not able to exchange enough oxygen, the surgeon may place the recipient on cardiopulmonary bypass. Their blood will be filtered through a machine outside the body which will put oxygen into their blood and remove carbon dioxide.
Three connections will be used to attach the new lung. These connections are called anastomoses. First, the main bronchus from the donor lung is attached to the recipient.
Double Lung Transplant
If both lungs are transplanted (a bilateral transplant), the surgeon will make an incision below each breast, called an anterior thoracotomy, or an incision that goes from the right side to the left side at the base of the breasts. This is called a transverse sternotomy incision. In a bilateral lung transplant, each lung is replaced separately. The surgeon begins by removing the lung with the poorest function. The recipient will be ventilated using their remaining lung unless partial cardiopulmonary bypass is needed. Once the first lung is removed, a donor lung will be attached using three connections. The donor bronchus is attached to the recipient
Finally, your incision is closed and you are taken to the intensive care unit (ICU).
Post Lung Transplant
After surgery, you will go to the cardiothoracic surgery intensive care unit (ICU) where a doctor and nurses are always very close by if you need anything. At first, you will be under the effects of anesthesia. You will have many IVs, special tubes and initially a breathing tube. Once you wake up and breathe on your own, the breathing tube will be removed. With either incision, nerves can be cut resulting in various degrees of decreased sensation.
Various tubes and equipment will be used to monitor how well your lungs and body are recovering after surgery:
A typical stay in the ICU is three to seven days. You will then be transferred to the thoracic surgery floor where our nurses and physical therapists will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. If all goes well, you can expect to spend one to two weeks on the thoracic surgery floor before your discharge.
Lung Transplant Complications
Most people who receive a lung transplant will develop one or more complications after their surgery. Most of these complications are minor, treatable and no cause for alarm. Your transplant team will help you understand early warning signs, be available to discuss your care and recommend further treatment when necessary.
Some of the most common complications seen after lung transplant are:
- Rejection is the most common complication following transplant surgery. It happens when the immune system, which defends the body against foreign agents such as viruses or bacteria, treats a transplanted organ as foreign and tries to attack it. To prevent your body from rejecting your new lung, you will take medications called immunosuppressants which lower your immunity or defense against foreign agents. These medications, when taken on time and as prescribed, reduce the risk of severe rejection which can damage the lung. You will take these medications for the rest of your life.
- As a lung transplant recipient, you will be more susceptible to infection because you will take immunosuppressant medications to help prevent rejection. The risk of infection from bacteria, viruses, and fungi are greatest in the early period after transplant when dosages of medicines are at their highest.
- The most common late complication of lung transplant is the development of bronchiolitis obliterans or obliterative bronchiolitis (OB). OB is an inflammatory disorder of the small airways, leading to obstruction and destruction of pulmonary bronchioles. The term bronchiolitis obliterans syndrome (BOS) refers to chronic lung rejection. BOS affects up to 50 percent of lung transplant patients within five years of the transplant and is perhaps the main impediment to prolonged survival.
- Many transplant recipients take blood pressure medications, since prednisone and cyclosporine, two of the medications used to limit rejection, can raise blood pressure.
- Some of the immunosuppressant medications that you take may increase your chance of developing diabetes. Diabetes is an increased level of sugar in your blood. Signs of diabetes include excessive thirst, frequent urination, blurred vision, drowsiness, or confusion.
- Cytomegalovirus (CMV) is a very common virus. About 70 percent of adults have been exposed to CMV at some time. It usually causes a flu-like illness with fever, body aches, and decreased appetite for two or three days. After exposure to the CMV virus, antibodies form in your blood to protect you from future exposures to CMV. This is similar to what happens after you have chickenpox. Because of the immunosuppressant medications, you will be at risk for CMV infection after transplant.