Lung Transplant Surgery
Overview
A lung transplant is a surgery that replaces a damaged or diseased lung with a healthy lung from a donor. Surgeons may transplant one lung or both, based on what the patient needs. In some rare cases, a heart may be transplanted at the same time as the lungs.
Most people who undergo lung transplants have already tried other treatments or medicines. The surgery carries risks, but it can help many patients breathe better and be more active in their daily lives.
Main aspects of lung transplantation:
- Type of Surgery: Single or double lung transplant.
- Donor Source: Usually from a deceased donor.
- Goals: Improve breathing and quality of life.
- Risks: Possible complications and need for ongoing care.
Reasons for Having a Lung Transplant
Diseases and injuries can damage lungs so severely that they no longer provide enough oxygen to the body. Doctors consider lung transplants for people with severe, long-term lung conditions that do not respond to medications or other treatments. Some of the main conditions that might lead to a lung transplant include:
- Chronic Obstructive Pulmonary Disease (COPD): This includes emphysema and chronic bronchitis, both of which damage the lungs over time.
- Pulmonary Fibrosis: Scarring in the lung tissue, such as idiopathic pulmonary fibrosis, makes breathing hard and affects oxygen levels.
- Cystic Fibrosis: This inherited disease causes thick, sticky mucus to build up in the lungs and can lead to repeated infections and blocked airways.
- Pulmonary Hypertension: High blood pressure in the lungs can make the heart work harder and can lead to failure of the right side of the heart.
- Other Advanced Lung Diseases: These can include bronchiectasis, sarcoidosis, lymphangioleiomyomatosis, alpha-1 antitrypsin deficiency, and bronchopulmonary dysplasia.
When less invasive treatments, such as medications or breathing support, do not improve symptoms, and lung function is very poor, doctors may recommend a transplant. Some people with severe heart and lung problems might need a combined organ transplant.
What Can Affect Your Chances of Getting a Lung Transplant
Transplant teams review every patient carefully to decide if a lung transplant is the best option. Several things can affect this decision:
| Potential Limiting Factor | Examples |
|---|---|
| Current infections | Active bacterial, viral, or fungal infections in the body. |
| Recent history of cancer | Cancer diagnosis or treatment in the past few years. |
| Other serious health problems | Advanced heart, kidney, or liver disease. |
| Lifestyle risks | Ongoing smoking, heavy alcohol use, or not willing to follow health advice. |
| Lack of social support | Few family members or friends to help after the surgery. |
Patients who do not have these risk factors and meet other health standards are more likely to qualify for lung transplantation. Strong support from family or friends and a commitment to ongoing care, such as taking medications regularly and attending checkups, are important for good results after the transplant.
Potential Complications
Likelihood of Organ Rejection
After a lung transplant, the immune system may see the new lung as a threat and try to attack it. This immune response is called rejection. Even with a good donor match, the body’s natural defenses can target the new lung, especially in the first months after surgery. Doctors prescribe medicines that suppress the immune system to lower this risk. Patients must take these medicines every day for life.
| Factor | Effect on Rejection Risk |
|---|---|
| Time after surgery | Highest at first, lowers over time |
| Organ match | Better match, lower risk |
| Medication use | Reduces rejection chances |
Effects of Drugs to Prevent Organ Attacks
Drugs that suppress the immune system to protect the transplanted lung can cause high cholesterol, weight gain, stomach trouble, and changes in hair growth. Some people may develop chronic diseases such as diabetes, kidney problems, or osteoporosis after long-term use. These drugs may also increase the risk of some cancers and high blood pressure.
Common Drug Side Effects
- Weight changes
- Hair loss or growth
- Digestive issues
Possible Long-Term Complications
- Kidney disease
- Cancer
- High blood pressure
- Diabetes
Greater Risk of Illnesses
Because immune-suppressing drugs weaken the immune system, infections become more likely, especially in the lungs. People with chronic lung or pulmonary diseases and those who have had a transplant need to be extra careful. They should wash their hands often, stay away from crowds, avoid sharing items, and protect their skin from cuts.
Vaccinations and regular dental care are also important steps. These actions help prevent lung infections, bronchial problems like bronchiolitis obliterans, and other serious complications.
Getting Ready for Lung Transplant Surgery
Beginning the Process
Patients usually start the lung transplant process by working with a care provider to get a referral or by choosing a transplant center independently. Patients should verify with their insurance provider which centers are covered.
Comparing programs by looking at how many transplants they perform and checking recipient survival rates can help—these details are publicly available through the Scientific Registry of Transplant Recipients. Extra services, such as support groups, travel help, and suggestions for places to stay during recovery, can make a big difference.
After selecting a transplant program, the medical team reviews the patient’s health history, conducts a full physical check, and orders lab and imaging tests. Doctors also assess mental and emotional health, as coping skills can impact recovery.
The transplant team and patient discuss what to expect during each phase of transplant, including benefits, risks, side effects, and possible complications. The team may also talk about the possibility of a living donor option, if it applies. Key points to consider:
| Task | Why It Matters |
|---|---|
| Insurance check | Coverage for procedures |
| Center statistics review | Quality and outcomes |
| Extra services | Support during process |
| Medical & emotional exams | Ensure best match |
Being on the Waiting List
After the transplant team approves a patient for a lung transplant, they register the patient on an official waiting list. Because more people need lungs than there are available organs, some may wait weeks, months, or even years. During this time, doctors monitor the patient’s health and adjust treatment plans as needed.
Patients should eat well, exercise if possible, and quit smoking if they have not already. Joining a pulmonary rehabilitation program is strongly recommended. These programs help patients build strength and learn new breathing and movement skills, which can make both surgery and recovery easier. The United Network for Organ Sharing (UNOS) matches donors to recipients based on several factors, such as:
- Blood type
- How well the donor lung fits into the patient’s chest
- Distance from donor to recipient
- Severity of lung illness
- General health status
- Chances of transplant success
Healthy habits that support waiting-list patients:
- Follow the treatment plan and take all medicines as instructed.
- Keep up with medical checkups and recommended screenings.
- Attend all rehabilitation sessions.
- Maintain updated contact information with the transplant center.
Sample Healthy Lifestyle Checklist
| Activity | Frequency |
|---|---|
| Exercise | As advised by doctor |
| Nutritious food | Daily |
| No smoking | Ongoing, no exceptions |
| Pulmonary rehab | Several times weekly |
If a living donor is an option, the team will provide details on how this works and may begin a separate evaluation process for the donor and recipient.
Final Steps Before Surgery
The call for surgery can come at any time, often with little notice. Patients should keep their phones close, have a hospital bag ready, and arrange transportation in advance. They often need to get to the hospital within a few hours after getting the call.
At the transplant center, the team performs quick but thorough checks, including more tests to confirm the patient’s health and make sure the lung is the right match. The medical team also examines the donor lung to ensure it is healthy enough for transplant.
Sometimes, tests or other issues mean the surgery cannot proceed. The transplant only goes forward if all signs show a good chance of success for both the organ and the patient. A basic readiness checklist:
- Updated contact information shared with the transplant team.
- Travel plan and backup in place.
- Packed bag with medication and essentials.
- Knowledge of the hospital admission process.
Staying prepared helps reduce delays and increases the likelihood of the surgery moving forward when the right donor lung becomes available.
What You Can Expect
What Happens While You Have Your Lung Operation
Doctors give patients general anesthesia before their lung transplant operation, so patients are asleep and do not feel anything during surgery. The anesthesiologist places a breathing tube through the mouth and down the airway to help with breathing.
The surgeon makes a cut in the chest and removes the lung that is not working. For single lung transplants, the surgeon removes only one lung, but for double lung transplants, both are removed and replaced.
In some surgeries, a heart-lung bypass machine temporarily takes over the job of the heart and lungs, keeping blood moving through the body while the old lung is removed and the new lung is attached. For the most complex cases, especially heart-lung transplantation, the team may use cardiopulmonary bypass or ECMO (extracorporeal membrane oxygenation).
The surgeon carefully places the new lung in position and connects the main airway and blood vessels to the donor lung. In rare situations, a heart-lung transplant involves replacing both the heart and the lungs. The medical team works through each step and checks that all connections are secure. Here’s a breakdown for different types of transplants:
| Type of Transplant | Estimated Surgery Time | Devices Possibly Used |
|---|---|---|
| Single lung transplant | 4–8 hours | Heart-lung machine, ventilator |
| Double lung transplant | 6–12+ hours | Heart-lung machine, ventilator |
| Heart-lung transplant | 8–12+ hours | Cardiopulmonary bypass, ECMO |
Doctors and nurses closely monitor the patient’s heart rate, blood pressure, and oxygen levels throughout the surgery. The operation’s length depends on its complexity and any unexpected issues that arise.
What Occurs After Your Lung Operation
After surgery, patients wake up in the intensive care unit (ICU). The care team monitors them around the clock. A ventilator assists with breathing during the first few days, until the new lung or lungs function well enough on their own. Tubes in the chest drain extra fluids that may collect around the lungs or heart.
Doctors give pain control medications through a tube in the vein. They also start medicines to keep the body’s immune system from attacking the new lung. Patients may stay in the ICU for a few days, depending on how they respond.
Once patients are stable and breathing without the ventilator, the care team moves them to a regular hospital room to continue recovery. The total hospital stay usually lasts between one and three weeks, but this can vary. During the weeks after surgery, the transplant team checks for problems like rejection or infection.
Patients may need frequent lab tests, chest X-rays, lung function tests, and sometimes a lung biopsy. In a lung biopsy, doctors remove a tiny piece of lung to check for rejection or infection. Doctors can perform this during a bronchoscopy—a test where a small, flexible tube with a camera goes into the lungs. This lets doctors see and treat issues early.
After leaving the hospital, patients need several months of close follow-up. Most people stay near the transplant center during the first three months because they need regular appointments. Healthcare providers look for signs of rejection, such as trouble breathing, fever, coughing, or chest congestion. Patients should report these symptoms immediately. Regular checkups after a lung transplant can include:
- Laboratory blood tests
- Chest X-rays
- Electrocardiograms (ECGs)
- Special breathing tests
- Bronchoscopy procedures
- Lung tissue biopsies
The transplant team helps patients manage immunosuppressant medicines. Patients must take these medications every day to prevent lung rejection. Because immunosuppressants lower the immune system’s ability to fight germs, doctors may also give antibiotics or antifungal medications. The team teaches patients how to prevent infections and spot them early. Common long-term requirements after a transplant:
- Taking medicines every day. Patients must use immunosuppressants and other drugs as instructed.
- Keeping a medication schedule. Setting daily reminders and carrying a list of medicines at all times helps in emergencies.
- Attending all follow-up visits. Patients should bring questions or health concerns to these visits.
- Staying close to the medical team at first. Frequent visits help detect any early problems.
Healthy Living Tips
- Avoid all tobacco products.
- Do not drink alcohol or only in moderation, as guided by the provider.
- Follow a healthy, balanced diet.
- Take part in an exercise program designed for transplant patients.
The care team often starts pulmonary rehabilitation just days after the operation. This program helps patients regain strength and teaches breathing exercises. The health care team personalizes each plan based on individual needs.
Signs of Possible Organ Rejection
- Shortness of breath
- Fever
- Cough or increased mucus
- Tightness or pain in the chest
If these happen, contact the transplant team as soon as possible for quick treatment. Besides physical changes, recovery can feel overwhelming. Many patients experience stress or anxiety.
The health care team provides emotional support, and many transplant centers offer group meetings or counseling. Patients are encouraged to reach out for help. Main procedures that can be part of post-transplant care:
| Procedure | Purpose |
|---|---|
| Bronchoscopy | Check airways, collect samples |
| Lung biopsy | Look for signs of rejection or infection |
| Lung function test | Measure how well the new lung is working |
Results
Lung transplantation often brings better breathing and daily comfort for many patients. The first year after surgery is especially important due to higher risks of infection, rejection, and surgical complications.
Key Points
- Quality of life can increase after surgery.
- About 50% of patients live for at least five years.
- Some patients reach or even pass the ten-year mark.
- Re-transplant may be needed in certain cases.
Coping and Support
Transplant patients often face stress, worry, or sadness. Trusted friends and family can offer encouragement and a place to share feelings. The multidisciplinary team—including doctors, nurses, social workers, dietitians, and pharmacists—guides patients through recovery. Ways to manage stress and find support:
- Connect with Support Groups: Meeting others who have had similar experiences can help patients feel less alone and reduce anxiety.
- Seek Professional Help: Mental health specialists and social workers can give guidance and may suggest treatment if someone feels depressed.
- Use Rehabilitation Services: Social workers help patients connect with job or activity programs when it’s time to return to daily routines.
- Set Realistic Expectations: Recovery takes time, and knowing what to expect can make it easier to adjust to changes.
- Learn About Your Health: Patients are encouraged to ask questions and stay informed. A better understanding of the process helps people feel more in control of their care.
These supportive steps, combined with help from the care team, can improve well-being during the transplant process.
Immunosuppressant medication
People who receive a lung transplant must take immunosuppressant medicines every day for the rest of their lives. These medications stop the body from attacking the new lung. Without them, the immune system would see the new organ as a threat and try to destroy it.
Doctors often use a mix of drugs to lower the chances of rejection, and they may change the specific combination over time to fit each person. Healthcare providers watch for side effects and signs of rejection to make sure the treatment works.
Types of Immunosuppressant Medicines
| Drug Type | Common Uses or Notes |
|---|---|
| Glucocorticoids | Used to prevent rejection, can cause weight gain and other side effects |
| Monoclonal Antibody | Given after surgery, often during first few days |
| Nucleotide Blockers | Used to help prevent organ rejection |
| Calcineurin Inhibitors | Key drugs after transplant, can impact kidney function and other organs |
| mTOR Inhibitors | Sometimes used when other drugs cannot be tolerated, or for kidney issues |
Doctors often use corticosteroids early on. These drugs help stop rejection but may cause side effects such as high blood sugar, bone problems, or increased body weight. Other immunosuppressive medications are also standard but can sometimes cause problems for the kidneys or other organs.
Doctors may suggest mTOR inhibitors a few months after surgery, especially if someone cannot take certain other drugs. These medicines can also help if a person develops kidney problems from calcineurin inhibitors; switching may help the kidneys recover or work better.
Occasionally, doctors use monoclonal antibodies like basiliximab right after surgery to provide extra protection against rejection. Health professionals work closely with patients, adjusting medication types and doses to reduce side effects and lower the chances of rejection.
Because immunosuppressants weaken the body’s defense system, people become more prone to infections. Doctors may suggest antibiotics or other medicines to help protect from certain illnesses while on these drugs.
Diet and Nutrition
A balanced diet is important for people with a new, healthy lung. Eating regular meals and choosing foods that are low in fat and cholesterol can help maintain a safe weight and support healing. Include lean meats, low-fat dairy, whole grains, and plenty of fruits and vegetables in daily meals. Tips for healthy eating after a lung transplant:
- Space out meals throughout the day.
- Limit very salty or fatty foods.
- Avoid grapefruit, pomegranate, blood orange, and black licorice as these can affect medications.
Keeping Active After Lung Transplant
Staying physically active is an important part of recovery and ongoing health after a lung transplant. Regular movement helps with many aspects of health, including blood pressure, stress management, bone strength, body weight, and daily function. Over time, being active can help the body use oxygen better.
A personal exercise plan fits each person’s needs. Many transplant centers offer pulmonary rehabilitation, which combines exercise and education to support better breathing and daily life. During rehab, people learn about safe ways to exercise, nutrition, and breathing techniques. Common parts of a recommended exercise plan:
- Warm-up: Gentle stretching or slow walking.
- Main Activities: Walking, cycling, or strength exercises.
- Cool-down: Slowly decreasing activity, like walking at a slower pace.
Tips to Remember
- Follow the plan that the care team creates.
- Always warm up before, and cool down after, the main activity.
- Take breaks when feeling tired.
- If symptoms like dizziness or shortness of breath appear, stop exercising.
- Call a health provider if symptoms do not go away.
Below is a simple example of a weekly activity plan:
| Day | Activity | Time |
|---|---|---|
| Mon | Walk | 20 mins |
| Wed | Cycle | 15 mins |
| Fri | Strength exercises | 10 mins |
Talk to the treatment team to choose the right activities. The team will adjust each person’s program based on how they feel and their level of fitness.
