Alternative Names pulmonary transplant, transplantation of the lungs
Definition In lung transplantation, a healthy donor lung is removed from a person who is brain dead and implanted into a person with lung disease who needs a healthy lung. Sometimes one lung is transplanted and sometimes a person is in need of a double lung transplant.
Who is a candidate for the procedure? Lung transplantation is only offered to persons who have severe failure of their lungs. These are people who doctors feel will not live longer than 1 to 2 years unless they receive a replacement lung. The main reasons for having a lung transplant include:
pulmonary fibrosis, a respiratory disease caused by inhaling asbestos fibres
cystic fibrosis, an inherited disease that affects the respiratory and digestive systems
alpha-1-antitrypsin deficiency, a deficiency of a protein produced in the liver that is associated with emphysema and liver disease
pulmonary hypertension, a condition in which pressure in the blood vessels of the lungs increases. This increased pressure causes damage to the blood vessels and heart.
decreased lung function that interferes with normal activities
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a lung transplant. This team includes surgeons, lung specialists known as respiratory phycians, social workers, nurses, and transplant co-ordinators. A few conditions would disqualify a person from receiving a lung transplant. These include:
severe lung, liver, or kidney problems that would make the operation too risky
A candidate for a lung transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new lung because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new lung. These medications need to be taken for as long as the new lung functions. The person will also need lifelong follow-up with doctors.
If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a lung from a donor.
How is the procedure performed? Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor. There may be two or three teams who operate on the donor at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
Usually, both lungs are taken out together. If a double lung transplant is to be done, the double lung will be transplanted together. If two single lung transplants are needed, that is, for two separate recipients, the lungs can be separated after they are removed from the donor.
The lungs can only be preserved safely for about 5 to 6 hours. The transplant surgery needs to take place within this time frame.
The recipient is given general anaesthesia. This means that the person is put to sleep with medications and feels no pain. The person is put on a ventilator, or artificial breathing machine, during the surgery. The person is then put on a heart-lung bypass machine. This involves special tubes to move blood around the heart and lungs. The blood is sent into a special machine to keep the blood circulating and full of oxygen. The operation consists of three major parts:
The diseased lung is cut away from its main blood vessel attachments to the heart and to the large airway, known as a bronchus.
The new healthy lung is put in place. The blood vessels and bronchus are connected to the new lung.
Blood flow and airflow are restored to the new lung. The surgeon checks carefully to see if there is any bleeding and if the lung is filling normally with air.
If the new lung is working properly, the incision is closed. The recipient is then taken to the intensive care unit for recovery.
A double lung transplant is done much like two single lung transplants. The surgeon starts with the more diseased lung, removes it, implants the new one, and then moves on to the less diseased side.
What happens right after the procedure? The transplant recipient will usually be in the hospital for 7 to 10 days. The person may be on a ventilator overnight to help with breathing. If the person is stable and the donor lung is functioning normally, the breathing machine may be removed at the end of the surgery. The recipient is usually well enough to move out of the intensive care unit after 2 to 3 days.
Immunosuppressant medications are given immediately before or during the surgery. Blood tests will be done in the first few weeks after transplantation to be sure that the correct dosage of the medications are being given. The recipient will continue to take these medications for the rest of his or her life.
Before leaving the hospital, the person will be given instructions including
how to care for the transplant
how to take the medications
what side effects to expect
how to take care of the surgical scar
early signs and symptoms of rejection
physical activity and rehabilitation
breathing exercises to prevent pneumonia
What happens later at home? At home, the recipient can expect a slow but steady recovery. Walking is encouraged to help prevent pneumonia and other lung complications. Walking also helps the person to regain strength. Heavy lifting and straining should be avoided for several weeks. Driving is permitted once the incision heals.
What are the potential complications after the procedure? There are several complications that can affect a recipient of a lung transplant. Some of these can occur right after the surgery and others can occur at any time for the rest of the person's life. Complications include:
infection. A person who takes immunosuppressant medications is more vulnerable to infection. Some infections are minor but some can be life threatening. This is especially true for infections that affect the lungs directly.
major bleeding. This is rare, but in some cases, there is a lot of scarring on the lung and other nearby tissue. These areas may bleed. Sometimes a second operation is needed to remove any blood clots and control the bleeding.
rejection. The body's normal response to a transplanted organ is to reject it. Even though they take medications to prevent rejection, most recipients will have one or more episodes of rejection. These are treated by increasing the dose of the medication or switching to a different medication.
cancer. This is another long-term problem with immunosuppressant medications. The most common cancers that develop are skin cancer and lymphoma, a cancer of the white blood cells.
Author: Robert Merion, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 16/09/2004 Contributors Potential conflict of interest information for reviewers available on request
