Lung Transplant

What is a lung transplant?

A lung transplant is a type of surgery that replaces your diseased or damaged lung with a donated lung. Most donated lungs come from a deceased person.

To receive a lung transplant, you must have a serious lung condition that doesn’t respond to medications and other treatments.

What are the main types of a lung transplant?

There are three main types of lung transplant:

• Single lung transplant. Your healthcare providers will remove one of your diseased or damaged lungs and replace it with a donated lung.
• Double lung transplant. Your healthcare providers will remove both of your lungs and replace them with donated lungs.
• Heart-lung transplant. Your healthcare providers will remove your heart and both of your lungs and replace them with a donated heart and lungs.

Who is a good candidate to have a lung transplant?

In general, you’re a good candidate for a lung transplant if:

• You have a condition or disease that prevents your lungs from working properly.
• Your lungs haven’t responded to medications or other treatments.
• You have a life expectancy of fewer than one to three years if you don’t get a transplant.
• You don’t have lung cancer.
• You don’t use tobacco products.
• You’re able to take immunosuppressive drugs.

Why is a lung transplant performed?

Your healthcare provider may recommend a lung transplant if you have a lung condition or injury that hasn’t responded to medications or therapies.

What does a lung transplant treat/manage?

Lung transplantation may treat many different conditions, including:

• Bronchiectasis.
• Chronic obstructive pulmonary disease (COPD).
• COVID-19.
• Cystic fibrosis (CF).
• Interstitial lung disease (ILD).
• Lung injuries.
• Pulmonary hypertension.

How common are lung transplants?

In 2019, healthcare providers performed about 2,500 lung transplants. However, more people need a lung transplant than are transplantable lungs available. Several hundred people die each year while waiting for a lung transplant, and lung transplant providers are working very hard to increase the number of lungs that can be transplanted to address this need.

What happens before a lung transplant?

Before a lung transplant, you must go through a thorough pre-transplant screening. A pre-transplant screening is the first step in determining if a lung transplant is the best treatment for you. A special healthcare provider known as a transplant coordinator will gather medical information about you and your condition. This information includes:

• Your overall physical health.
• Your family health history.
• Prescribed medications, especially blood thinners.
• Recent computed tomography (CT) scans and chest X-rays.
• Blood tests.
• Tissue typing (a test that makes sure your body tissues are compatible with the lung donor’s tissues).
• Pulmonary function tests.
• Ventilation perfusion scan (measures how much blood flows to your lungs and how much air each lung receives).
• Heart tests (electrocardiogram, echocardiogram and cardiac catheterization).
• Sigmoidoscopy or colonoscopy.
• Bone density test (DEXA scan).

Your healthcare provider will conduct a Pap smear and a mammogram for women and people assigned female at birth (AFAB). Your healthcare provider will conduct a prostate exam for men and people assigned male at birth (AMAB).

After your pre-transplant screening, your transplant coordinator and other members of your lung transplant team will meet. They’ll evaluate your tests and discuss whether a lung transplant is the best treatment.

Once your healthcare providers have finished their evaluations and determined you’re a good candidate for a lung transplant, they’ll put you on a national lung transplant waiting list.

You must match the following requirements with your donor:

• Blood type.
• Similar size lung.

Because there are so many people on the lung transplant waiting list, you may be on a lung transplant list for months or even years. You may die before a suitable donor is available. But if you don’t have any issues that make it difficult to find a matching donor, such as antibodies (proteins) in your blood that react against many donors, and you’re ill, you’ll likely receive a lung transplant within a few months of being placed on the waiting list.

What kinds of healthcare providers make up a lung transplant team?

The healthcare providers on your lung transplant team generally include:

• Transplant pulmonologist.
• Transplant surgeon.
• Anesthesiologist.
• Surgical nurses.
• Pharmacist.
• Dietitian.
• Physical therapist.
• Respiratory therapist.
• Pulmonary rehabilitation specialist.
• Social workers.
• Transplant coordinator.

What should I do while I’m on the lung transplant list?

Once you’re on the lung transplant list, your healthcare providers will work with you to create a healthcare plan. Your healthcare plan will include:

• Lifestyle changes. You must stop drinking alcohol, especially if you drank two or more drinks containing alcohol per day in the past. You must also maintain a consistent weight (or perhaps lose weight if you have obesity).
• Medications. Take all medicines as prescribed by your healthcare providers. Notify your transplant coordinator if another healthcare provider prescribes you antibiotics or changes your steroid dosages. Tell your transplant coordinator about any over-the-counter (OTC) medications you’re taking, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your risk of bleeding.
• Exercise programs. Your physical therapist will work with you to develop an exercise program. The program will keep you in the best physical condition before your transplant. A respiratory therapist will work with you to create a breathing exercise program to keep your lungs as healthy as possible.
• Regular appointments. You’ll have appointments with your lung transplant team members every two to three months to evaluate your overall health.
• Preparation. A donor lung may become available at any time. It’s important to have a transportation plan to the hospital in place. It’s also a good idea to pack an emergency bag of items that’ll make you feel more comfortable at the hospital. Your bag may include comfortable clothes, toiletries and reading materials.

What happens during a lung transplant?

Your healthcare provider will insert an intravenous (IV) line into a vein in your arm or hand. The IV delivers anesthesia into your body so you aren’t awake and won’t feel any pain during the lung transplant. They’ll monitor your heart and blood pressure with an electrocardiogram (EKG).

Your positioning on the operating table may depend on what type of lung transplant you need. While single lung transplants can be done with you lying on your back, you may lie on your side. You’ll lie on your back for a double lung transplant or a heart-lung transplant.

Once you’re asleep, your healthcare providers will connect you to a mechanical ventilator. A mechanical ventilator breathes for you. They’ll also insert a urinary catheter into your bladder. The catheter will collect any urine (pee) that your body produces during the procedure.

Your procedure may require a mini heart-lung machine called ECMO (extracorporeal membrane oxygenation). An ECMO machine allows your transplant surgeon to bypass blood flow to your heart and lungs. It pumps blood through your body. It also removes carbon dioxide and replaces it with oxygen, which helps keep your tissues healthy.

Your healthcare providers may need to prepare the area by shaving your chest. They’ll sanitize your skin with an antiseptic to kill any bacteria.

For a single lung transplant, your healthcare provider will use a sharp, sterile knife (scalpel) to make a cut (incision) on the side of your chest that contains the damaged lung that’ll be replaced. Some single lung transplants are done through an incision through your breast bone, as with heart surgery.

For a double lung transplant, your healthcare provider will use a scalpel to make a horizontal incision across your entire chest, underneath your breast tissue. An incision, as with heart surgery (sternotomy), can also be used for a double lung transplant.

Your healthcare providers will remove your diseased or damaged lung and replace it with your donor’s lung. They’ll connect your blood vessels and airways with small surgical needles and thread. Blood vessels allow your transplanted lung to receive blood (vascularization). Vascularization keeps your tissues alive.

Once your healthcare providers have confirmed that blood flows to your transplanted lung and air passes through your airways, they’ll place small silicone tubes in your affected areas to drain blood, fluid and air out of your chest. These drainage tubes also help your new lungs expand entirely.

They’ll also disconnect you from any machines that were used to facilitate the surgery. They won’t remove the mechanical ventilator or the catheter.

Finally, they’ll stitch (suture) your incision closed and cover your affected areas with bandages.

How long does a lung transplant take?

A lung transplant is a delicate procedure that requires a lot of time. Its length depends on whether you need a single lung transplant or a double lung transplant.

A single lung transplant may take four to eight hours.

A double lung transplant may take six to 12 hours.

What happens after a lung transplant?

After the lung transplant procedure is complete, your anesthesiologist will stop putting anesthesia into your body. You’ll move to an intensive care unit (ICU), where your healthcare providers wait for you to wake up and monitor your overall health. While in the ICU, the mechanical ventilator will continue to help you breathe.

Once your providers believe it’s safe, they’ll take you off the mechanical ventilator, remove the catheter and move you to a post-transplant unit. They’ll monitor how you and your body respond to immunosuppressive drugs and adjust your dosages as necessary.

As your body heals in the post-transplant unit, you’ll start working with physical therapists and respiratory therapists to build up strength in your body and lungs.

After you’ve made enough progress and your healthcare providers believe it’s safe, they’ll discharge you (let you go home). You’ll be in the hospital between 12 and 14 days after surgery or perhaps longer, if necessary.

What are the advantages of a lung transplant?

A lung transplant positively affects your overall quality of life. The primary advantages of a lung transplant include:

• Increased lifespan. About 55% of lung transplant recipients have a survival rate of at least five years after a lung transplant. Other recipients have continued living for up to 10 and even 20 years.
• More energy. Many lung transplant recipients have more energy to participate in everyday activities. Activities may include exercise and other physical activities.
• Increased fertility. It’s safe to get pregnant after a lung transplant. Many women and people AFAB report their fertility increased after receiving a lung transplant. It’s a good idea to talk to your healthcare provider about the risks involved in trying to have a baby after a lung transplant.

What are the risks or complications of a lung transplant?

A lung transplant has many risks, including:

• Surgical risks. All surgeries have risks. Risks may include anesthesia complications, bleeding, blood clots, unfavorable scarring, infection and death.
• Transplant rejection. Your immune system protects your body from foreign invaders that cause your body harm. Foreign invaders include bacteria, viruses, parasites and fungi. Transplant rejection occurs when your body’s immune system attacks your transplanted lungs. It interprets the lungs as foreign invaders. Transplant rejection is most common in the first 12 months (called acute rejection) after surgery. Your healthcare provider can almost always reverse this form of rejection with extra immunosuppressive medications. There’s a form of rejection called chronic rejection that can occur in some people who are more than three years from their transplant. If it happens, it can be very difficult to treat and can lead to death or the need for another transplant. You must take immunosuppressive drugs for the rest of your life. The drugs reduce the risk of your immune system destroying your new lung.
• Infection. Immunosuppressive drugs slow down or stop your immune system from rejecting your new lung. However, a suppressed immune system has a hard time fighting off infections. You’ll have a higher risk of developing dangerous blood, fungal, skin and respiratory infections while on immunosuppressive drugs.

What are the signs of lung transplant rejection?

Several signs indicate your body is rejecting your transplanted lung. If you experience any of the following symptoms, contact your healthcare provider immediately:

• Fever.
• Weight gain.
• Nausea and vomiting.
• Tiredness.
• Body aches.
• Diarrhea.
• Sensitivity or tenderness around your transplanted lung.
• Swelling.

How long can you live if your body rejects your lung transplant through acute rejection?

With immediate diagnosis and treatment, most people recover after their body rejects their lung transplant.

Your healthcare provider will conduct tests to diagnose lung transplant rejection, including blood work and a bronchoscopy.

If your body rejects your lung transplant, your healthcare provider will administer high-dose corticosteroids through an IV, followed by corticosteroid pills.

In severe cases of lung transplant rejection, your healthcare may prescribe strong immunosuppressive drugs. These drugs may include antithymocyte globulin (Thymoglobulin®) or alemtuzumab (Campath®).

As mentioned, chronic rejection is much more difficult to treat and treatment is unpredictable. Some people respond and stabilize, while others deteriorate and die, or qualify for another transplant.

What is the recovery time after a lung transplant?

For at least three months after you leave the hospital, you must return frequently for regular treatment, therapy and monitoring. Your appointments will include physical therapy, blood tests and imaging tests.

Your incision should heal about two weeks after your lung transplant.

Although you’ll be walking in the hospital and when you leave the hospital, progression to other forms of light exercises will take about six to eight weeks after the procedure. You’ll be guided by your healthcare providers in this regard. Though exercise is necessary as you recover, listening to your body is also important. Stop and rest if you feel discomfort or pain. Avoid contact sports or activities that may affect your chest, including football, baseball, golf and bowling for about three months.

You should be able to drive about six to eight weeks after the procedure.

After three to six months, your risk of lung transplant acute rejection decreases and your lung function should stabilize.

Most people return to work or school after four to six months.

It’s important to remember that your body is unique. Your recovery times and benchmarks after your lung transplant may vary. It’s important to follow your healthcare provider’s instructions.

When should I see my healthcare provider?

After a lung transplant, schedule regular follow-up appointments with your healthcare providers. You may require multiple appointments every week for testing and therapy for six months after your procedure.

Call your healthcare provider immediately if you aren’t feeling well or if you notice any discomfort or changes to your transplant site.

Talk to your healthcare provider before you start taking any new medicines. New medications may include prescribed and OTC medications and herbal supplements.

A note from Cleveland Clinic

A lung transplant is a serious surgery with the potential to improve your quality of life. You must go through a thorough pre-screening before you’re placed on the lung transplant waiting list. Once you’re on the list, you must be diligent to maintain physical activity and fitness, maintain nutrition and adhere to the agreed-upon medical plan. The recovery process after a lung transplant is long. Your body is more likely to reject your lung within the first year after the procedure.

Getting a lung transplant is a major decision. Your healthcare provider is available to answer your questions and make sure you’re comfortable with your choices.