Lung transplant: A treatment for life-threatening lung disease

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Lung transplant: A treatment for life-threatening lung disease

Lung transplant — If your lungs no longer function adequately, a transplant may offer hope.

Damage to various structures in your lungs can affect how well you breathe and how efficiently your lungs exchange oxygen and carbon dioxide as you inhale and exhale. If medication or special breathing devices are no longer helpful or poor lung function is life-threatening, your doctor may recommend a lung transplant.

If you're considering a lung transplant, here's what you need to know about the transplant process, the surgery itself, potential risks and follow-up care.

What should I consider when choosing a transplant center?

If your doctor recommends a lung transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

When you're considering transplant centers, ask about the number and type of transplants the center performs each year, as well as its organ and recipient survival rates. You can compare transplant center statistics through a database maintained by the Scientific Registry of Transplant Recipients.

Also consider additional services provided by the transplant center. Many transplant centers coordinate support groups, assist with travel arrangements, help secure local housing for the recovery period and offer referrals to other helpful resources.

Do I need to be accepted by the transplant center?

Yes. When you select a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements for a lung transplant. The team at the transplant center will assess whether you:

  • Are healthy enough to have the surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would hinder transplant success
  • Are willing and able to take medications as directed
  • Are committed to quitting smoking, if you smoke
  • Have family and friends to support you during this stressful time

Will I be placed on a waiting list?

If the team at the transplant center determines that you're a good candidate for a lung transplant, you'll be placed on a nationwide waiting list. According to the Organ Procurement and Transplantation Network, about 3,500 people are waiting to receive a lung transplant on any given day — but there are only enough donor organs to provide about 1,000 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.

What about a living-donor lung transplant?

Living-donor lung transplants are rare, but possible — usually in children. Typically one healthy adult donates a lobe, or segment, from a left lung, and another donates a lobe from the right lung. The lobes don't regenerate, and the procedure carries serious risks. However, the ability to schedule the procedure ahead of time allows the recipient to begin taking immune-suppressing medication earlier, which reduces the risk of organ rejection.

What can I do to prepare for the lung transplant?

When you're waiting for a donated lung to become available, it's important to keep your mind and body healthy.

  • Take your medications as prescribed.
  • Follow your diet and exercise guidelines.
  • Keep all appointments with your health care team.
  • 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 only remains viable 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. You'll most likely be expected to arrive at the hospital within about two to three hours.

Before surgery, the surgeon will also do a final assessment of the donor lung to ensure it's healthy and a good match. If there are problems with the donor lung, the transplant may be canceled.

What happens during the transplant?

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.

What can I expect after the 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 two-week hospital stay and about three months of frequent monitoring by the lung transplant team. During this time, you'll need to stay fairly close to the transplant center.

Even with the best possible match between you and the donor, your immune system will try to reject the new lung. Your drug regimen will include medications to suppress your immune system. You'll likely take these or other drugs for the rest of your life.

Some of these medications 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.

Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications. Some immune system medications can also increase the risk of developing or aggravating conditions such as high blood pressure, high cholesterol and cancer.

Your post-transplant treatment will be a delicate balancing act between preventing rejection and managing unwanted side effects. Your doctor will monitor your treatment closely and adjust it as needed. You'll also need to follow a diet and exercise program designed to keep your new lung healthy. Smoking isn't allowed, and use of alcohol is strictly limited.

What are typical survival rates?

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.

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 — nearly 82 percent at one year, nearly 64 percent at three years, and more than 48 percent at five years.

What if my new lung fails?

Organ rejection is possible, and sometimes the underlying cause of lung disease damages the new lung.

If your new lung fails, subsequent treatment options are limited. You may choose to discontinue treatment. This important decision depends on your current health and your expectations for maintaining a certain quality of life. Discuss the choices with your doctor, transplant team and family to determine what's best for you.

Last Updated: 12/15/2006
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