Lung Transplant

A lung transplant is a type of surgery that removes your diseased or damaged lung and replaces it with a healthy donated lung. Donated lungs come from a deceased person.

To get a lung transplant, you must have a serious lung condition that doesn’t respond to other treatments or medications. You’re a good candidate for the procedure if you:

• Have a life expectancy of fewer than two years if you don’t get a transplant
• Don’t use tobacco products
• Can take immunosuppressants
• Can follow a medication schedule and attend regular follow-up visits
• Maintain a healthy lifestyle by eating well and getting regular physical activity

Types

There are three main types of lung transplant:

• Single lung transplant: Surgeons remove only one of your lungs and replace it with a donated lung.
• Double lung transplant: Surgeons replace both of your lungs with donated lungs.
• Heart-lung transplant: Surgeons replace your heart and both lungs with a donated heart and lungs.

What does it treat?

Diseased or damaged lungs can prevent your body from getting oxygen. Many different conditions can affect how well your lungs work. Some common conditions include:

• Bronchiectasis
• Chronic obstructive pulmonary disease (COPD)
• Alpha-1 antitrypsin deficiency
• COVID-19 fibrosis
• Cystic fibrosis-related lung disease
• Interstitial lung disease (ILD) or pulmonary fibrosis
• Coal worker’s lung disease
• Pulmonary arterial hypertension (PAH)

For many, medications and therapies can help successfully treat these conditions. But when treatments no longer help, healthcare providers may suggest a lung transplant.

How common is it?

In 2023, providers performed over 3,000 lung transplants in the U.S. But there aren’t enough donor lungs available for people who need a lung transplant.

Increasing organ donation awareness is one of the best ways to increase the number of donor lungs. Providers do this through public events, presentations and media campaigns. Many people register as organ donors when they get a driver’s license or state ID card. They can also register online.

How should I prepare for a lung transplant?

If a provider recommends a lung transplant, you must go through an in-depth screening or evaluation. During the screening, members of your care team will:

• Review your health history and ask questions about your biological family history
• Perform a physical exam
• Order tests, including blood tests, imaging tests and pulmonary function tests, and then review your results
• Review and ask questions about your personal support team during the transplant period
• Ask questions about your mental and emotional health
• Review your medications
• Review your weight and your overall eating patterns for transplantation

After completing testing and meeting with transplant surgeons, they’ll present you to a selection committee. After their approval, they’ll place you on a national waiting list. You match with a donor by having compatible:

• Blood type
• Lung size
• Immunology, meaning your genes are close enough that your immune system is less likely to reject the donor lung

You must have the same blood type as your donor, and your lungs must be about the same size. You may be on the waiting list for months until a good match is available. Providers will give you a better idea of what to expect as far as your time on the waiting list.

What happens during the procedure?

A lung transplant is a major surgery. You’ll receive general anesthesia so you won’t be awake and won’t feel pain during the procedure. Once you’re asleep, your lung transplant team will:

1. Shave the surgical area, if necessary, and sanitize your skin with antiseptic to kill any bacteria.
2. Connect you to a mechanical ventilator, which breathes for you.
3. Insert a urinary catheter into your bladder to drain pee.
4. Connect you to an ECMO machine. This machine allows providers to bypass blood flow to your heart and lungs. It pumps blood through your body and removes carbon dioxide and replaces it with oxygen.
5. Use a sharp, sterile knife (scalpel) to make a cut (incision) in the surgical area. For a single lung transplant, the incision is on the same side of your chest as your damaged lung.
6. Remove your diseased or damaged lung and replace it with a donor’s lung.
7. Connect the donor lung to your blood vessels and airways.
8. Place small silicone drainage tubes in the affected areas to drain blood, fluid and air out of your chest.
9. Stitch your incision closed and cover the affected area with bandages.

How long does it take?

A lung transplant takes a lot of time. A single lung transplant takes about four to six hours. A double lung transplant takes about six to eight hours.

What happens after?

After the lung transplant is complete, your anesthesiologist will stop giving you anesthesia. Providers will move you to an intensive care unit (ICU). They’ll wait for you to fully wake up and monitor your overall health. While in the ICU, the mechanical ventilator will continue to help you breathe.

Once your care team thinks it’s safe, they’ll take you off the ventilator. They’ll also remove the catheter and move you to a post-transplant unit. They’ll monitor how you and your body respond to immunosuppressants. They’ll adjust your dosages as necessary. Immunosuppressants help prevent lung transplant rejection. Lung transplant rejection is when your immune system doesn’t accept your new lung and attacks it. It can happen in rare cases.

As you heal, you’ll start working with physical therapists and respiratory therapists. They’ll help you build up strength in your lungs and the rest of your body.

After you’ve made enough progress and providers think it’s safe, you can go home. Most people stay in the hospital for 12 to 14 days after a lung transplant. But your body is unique. Your hospital stay may be shorter or longer.

What are the benefits of a lung transplant?

A lung transplant can increase your overall quality of life. Examples include:

• Breathing is easier
• More energy for everyday activities, including exercise
• No longer need supplemental oxygen

What is the life expectancy?

A 2023 report lists the lung transplant survival rates as:

• Almost 90% after one year
• Over 70% after three years
• Almost 60% after five years
• Over 30% after 10 years

Some people live over 20 years after a lung transplant.

What are the risks or complications?

Potential lung transplant complications include:

• Surgical risks: All surgeries have risks. These include anesthesia problems, bleeding, blood clots and scarring.
• Transplant rejection: This is when your immune system attacks your new lung. It’s more common in the first 12 months after surgery (acute rejection). Chronic rejection is when it happens more than three years after surgery.
• Infection: You must take immunosuppressants for the rest of your life after the procedure. They help stop your immune system from attacking your donor lung. But a suppressed immune system has a hard time fighting infections. You’re at greater risk of getting infections while taking immunosuppressants.

How long does it take to recover from a lung transplant?

It takes a long time to make a full recovery after a lung transplant. Your progress will come in stages:

• It takes about two weeks for your incision to heal.
• In most cases, you’ll be able to walk and work with physical therapists and occupational therapists two to three days after the procedure. You must protect the incision by limiting your lifting as you recover. You can’t carry anything greater than 10 pounds (a little more than a gallon of water) for the rest of your life.
• You should be able to drive after about six to eight weeks.
• After 12 months, your risk of lung transplant rejection decreases. Your lung function should continue to improve every few months. You should reach a stable lung function about a year after the procedure.
• Expect to be out of school or work for about six months.

Remember, your body is unique. Your recovery times and benchmarks after surgery may be different. It’s important to closely follow your healthcare provider’s instructions. This helps ensure the fastest recovery.

When should I call my healthcare provider?

After a lung transplant, you’ll need regular follow-up appointments with your providers. Initially after your release from the hospital, you may need one or more appointments every week for lab tests, check-ups and therapy. Once you’re stable, you’ll see your providers about every three months in an outpatient clinic.

Call your provider immediately if you aren’t feeling well. Let them know if you notice any discomfort or changes to your breathing.

Talk to your provider before you start taking any new medicines after a lung transplant. These include prescribed and over-the-counter medications. They also include vitamins and herbal supplements. They may affect how well your immunosuppressants work.