What are the risks of transplantation?
The risks of transplantation are the same as those of any surgery. They include the risk of bleeding or infection. Some transplant recipients might also experience side effects from the medicines.
The two complications specific to transplant surgery are organ rejection and dysfunction of the graft (the transplanted organ). Since the body recognizes the new lung as a foreign object, it will normally try to get rid of it or "reject" it. Anti-rejection drugs taken after surgery help reduce the risk of rejection, but they also inhibit the immune system. Since the body's ability to fight infection is decreased, transplant recipients are more prone to infections, which ultimately affect the function of the transplanted organ.
Years of experience, research and improved medicines help prevent rejection, and your transplant team will take every precaution to prevent these complications. While you are recovering in the hospital, you will learn to recognize signs of rejection, graft dysfunction and infection.
What is transplant rejection?
The body's immune system protects you from infection. Immune cells recognize the transplanted lung as different from the rest of the body and attempt to destroy it. This is called rejection, and it is your body's way of not accepting the new organ.
After transplant surgery, you are prescribed immunosuppressive drugs to "fool" your immune system into thinking your new lung is your own so it doesn't try to attack it.
Fortunately, rejection can be treated, especially if the signs of rejection are recognized early. While you are in the hospital, your transplant team will constantly monitor you to detect signs of a rejection episode.
After you go home, it is vital for you to be aware of the possible signs of rejection so you can report them to your health care providers and be treated immediately. It is also very important for you to continuously take your medicines as prescribed, have your blood work drawn as scheduled, and follow your pulmonary function test and bronchoscopy schedules.
What are the warning signs of possible rejection?
If you are experiencing any of these symptoms, contact your transplant coordinator immediately:
- Fever over 100°F (38°C)
- "Flu-like" symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
- Chest congestion
- Cough
- Shortness of breath
- New pain with breathing
- Fatigue or generally feeling "lousy"
How is rejection identified?
The transplant team will be able to determine if your body is rejecting your new lung by completing daily tests of pulmonary function during your hospital stay. If the team thinks you might be experiencing any problems with your new lung, the following tests might be completed:
- Repeated blood work including a complete blood count
- Chest X-ray
- Lung biopsy and surveillance bronchoscopy — These tests are performed routinely as part of your follow-up care (at three weeks, six weeks, three months, six months, nine months, and one year after transplant surgery)
What is a lung biopsy?
A lung biopsy is a procedure in which several small samples of lung tissue are removed and tested. A lung biopsy is usually performed on an outpatient basis. Once the lung biopsy is complete, a microscope is used to examine the tissue samples and establish a diagnosis.
The actual lung biopsy generally takes between 20 to 30 minutes. You will be required to lie flat for two hours following the procedure to reduce the risk of bleeding. It is common for patients to cough up small clots of blood for a few days after a lung biopsy.
How is rejection treated?
If rejection develops, your doctor will prescribe medicine to treat rejection and prevent continued complications. In order to control the rejection, you might need to be admitted to the hospital, or you might receive care in an outpatient setting. First-line treatment involves administering high-dose steroids for three consecutive days.
Will rejection treatment cause side effects?
The medicines used to treat a lung rejection episode are strong drugs. The first few doses may cause the following side effects:
- Fever, chills
- Headaches
- Nausea, vomiting
- Weakness
- Diarrhea
- General flu-like symptoms
In order to help control these symptoms, you may receive a pre-medication of acetaminophen (Tylenol) and diphenhydramine hydrochloride (Benadryl) before each dose.
