• Lung Transplant

    Definition

    This is a surgery to remove severely diseased and damaged lungs. They are replaced with healthy lungs from a deceased donor. One or both lungs may be transplanted. In some cases, a heart transplant is done at the same time. In that case, the procedure is called a heart-lung transplant .

    Reasons for Procedure

    A lung transplant is done to treat irreversible, life-threatening lung disease, such as:
    Normal vs. Emphysemic Lung
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Possible Complications

    If you are planning to have a lung transplant, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Rejection of the donor lung (your body's immune system attacks the new lungs)
    • Conditions related to taking immunosuppressant drugs (increase your risk for infection and cancer)
    • Anesthesia-related problems
    • Death
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Before you have a lung transplant, you will go through an intensive evaluation. This is done to determine if you are a good candidate for this surgery. During the evaluation, which often requires a hospital stay, you will have some or all of the following tests:
    • Physical exam
    • Blood tests
    • Tissue typing
    • Electrocardiogram (ECG, EKG) —a test that records the heart's activity by measuring electrical currents through the heart muscle
    • Chest CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
    • Echocardiogram —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart
    • Pulmonary function tests —tests that measure the function of the lungs
    • Ventilation-perfusion lung scan—a test that examines the movement of blood and air through the lungs
    • Cardiac catheterization —a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply
    If you are a good candidate for a transplant, you will be put on a waiting list. There is a shortage of donors. You may need to wait a long time. You will need to carry a cell phone with you at all times. This will allow the transplant team to reach you if a donor lung becomes available. Donors are matched carefully for size, tissue type, and other factors. In some cases, a healthy family member can donate a lung if you only need a single transplant.
    Leading up to your procedure:
    • Arrange for a ride to and from the hospital. Also, arrange for help at home.
    • Take medicine as directed. Check with your doctor before taking over-the-counter medicine.
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • Eat a light meal the night before. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    For a single lung transplant, the doctor will make an incision on your side. It will be about six inches below your underarm. For a double lung transplant, the doctor will make an incision across the lower chest.
    You will be put on a ventilator and a heart-lung machine. This machine will take over the functions of the heart and lungs during surgery. Next, the doctor will remove a small section of rib. This will allow access to your lung. The old lung will be cut away from the main blood vessel and bronchus (large airway). The new lung will then be inserted. The doctor will attach the blood vessels and bronchus to the new lung.

    Immediately After Procedure

    You will stay in the intensive care unit (ICU) for 2-3 days. The doctors and nurses will monitor you.

    How Long Will It Take?

    • 4-8 hours for a single lung transplant
    • 6-12 hours for a double lung transplant

    How Much Will It Hurt?

    You will have pain during the recovery process. Your doctor will give you pain medicine.

    Average Hospital Stay

    This surgery is done in a hospital setting. The usual length of stay is 7-10 days. Your doctor may choose to keep you longer if you shows signs of rejecting the new lungs or have other problems.

    Post-procedure Care

    Ask your doctor about when it is safe to shower, bathe, or soak in water.
    For the rest of your life, do the following to maintain the health of your new lung or lungs:
    • Take immunosuppressive drugs. These drugs will help to prevent your body from rejecting the new lung. Only take drugs approved by your doctor.
    • Have regular lung biopsies . A sample of lung tissue will be taken at regular intervals to check for lung rejection:
      • Every three months the first year
      • Twice a year the second year
      • Once a year in subsequent years
    • Have blood tests done.
    • Measure your temperature, weight, and blood pressure levels regularly.
    • Make lifestyle changes, such as:
      • Avoiding exposure to tobacco smoke and other toxic elements
      • Exercising regularly to help maintain lung capacity
      • Limiting your intake of salt, foods high in fat and cholesterol, sweets, and alcohol
    It will take about six months to recover from a lung transplant.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills—You are at an increased risk for infection because of the immunosuppressive drugs.
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Cough, shortness of breath, chest pain, or severe nausea or vomiting
    • Increased sputum (phlegm) production
    • Coughing up blood
    • Waking up at night due to shortness of breath
    • Sudden headache or feeling faint
    • Changes in weight or blood pressure
    • Chest pain or sensation of your heart fluttering, missing beats, or beating erratically
    • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
    • Excessive tiredness or swelling of feet
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Lung Association http://www.lungusa.org/

    United Network for Organ Sharing http://www.transplantliving.org/

    CANADIAN RESOURCES

    Canadian Lung Association http://www.lung.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Lung transplant. Mayo Clinic.com website. Available at: http://www.mayoclinic.com/health/lung-transplant/MY00106 . Updated September 2010. Accessed November 12, 2010.

    Organ transplant. Duke University Medical Center website. Available at: http://organtransplant.mc.duke.edu/transplant.html . Accessed October 14, 2005.

    What is a lung transplant? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ . Updated December 2008. Accessed September 4, 2009.

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