Lung Transplant
Multimedia
Definition
Lung transplant is surgery to replace one or both diseased lungs with healthy lungs from a human donor.
Alternative Names
Solid organ transplant - lung
Description
The new lung or lungs are usually donated by someone under age 65 who is brain-dead but is still on life-support. The donor tissue must be matched as closely as possible to your tissue type to reduce the odds that your body will reject the transplanted lung.
Lungs can also be given by living donors. Two or more people are needed. Each person donates a segment (lobe) of their lung to form an entire lung for the person who is receiving it.
During lung transplant surgery, you are asleep and pain-free (under general anesthesia). A surgical cut is made in the chest. Lung transplant surgery is done with the use of a heart-lung machine, which does the work of your heart while your heart is stopped for the surgery.
For single lung transplants, the cut is made on the side of your chest where the lung will be transplanted. The operation takes 4 - 8 hours. In most cases, the lung with the worst function is removed.
For double lung transplants, the cut is made below the breast and reaches to both sides of the chest. Surgery takes 6 - 12 hours. Tubes are used to send blood to a heart-lung bypass machine to provide oxygen and move blood through the body during the surgery.
After the cut is made, the major steps during lung transplant surgery include:
One or both of your lungs are removed. For patients who are having a double lung transplant, most or all of the steps from the first transplant are completed before the second transplant is done.
The main blood vessels and airway of the new lung are sewn to your blood vessels and airway. The donor lobe or lung is stitched (sutured) into place. Chest tubes are inserted to drain air, fluid, and blood out of the chest for several days to allow the lungs to fully re-expand.
Sometimes heart and lung transplants are done at the same time (heart-lung transplant) if the heart is also diseased.
Why the Procedure Is Performed
A lung transplant is usually the last-resort treatment for lung failure. Lung transplants may be recommended for patients under age 65 who have severe lung disease. Some examples of diseases that may require a lung transplant are:
Lung transplant may NOT be done for patients who:
- Are too sick or badly nourished to go through the procedure
- Continue to smoke or abuse alcohol or other drugs
- Have active hepatitis B, hepatitis C, or HIV
- Have had cancer within the past 2 years
- Have lung disease that will likely affect the new lung
- Have severe disease of other organs
The doctor may recommend against a heart transplant if there is concern that you will not be able to keep up with the many hospital and doctor's visits, tests, and medications needed to keep the new heart healthy.
References
Smythe WR, Reznik Si, Putnam JB Jr. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 59.
Solomon M, Grasemann H, Keshavjee S. Pediatric lung transplantation. Pediatr Clin North Am. 2010; 57(2):375-391.
Flume PA, Mogayzel PJ Jr, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC; Clinical Practice Guidelines for Pulmonary Therapies Committee; Cystic Fibrosis Foundation Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: Pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med. 2010; 182(3):298-306.
Kotloff RM. Lung transplantation. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 95.
Review Date: 5/4/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Solid organ transplant - lung
After the Procedure
You should expect to stay in the hospital for 7 - 21 days after a lung transplant. You will likely spend time in the intensive care unit (ICU) right after surgery. Most centers that perform lung transplants have standard ways of treating and managing lung transplant patients.
During your hospital stay, you will:
Be asked to sit on the side of the bed and then walk on the same day you have surgery
Be asked to cough
Have a tube coming out of the side of your chest to drain fluids
Wear special stockings on your feet and legs to prevent blood clots
Get shots to prevent blood clots
Receive pain medicine through a tube that goes into your vein (IV) or by mouth with pills. You may have a special machine that gives you a dose of pain medicine when you push a button. This allows you to control how much pain medicine you receive.
Be asked to do a lot of deep breathing to help prevent pneumonia and infection, and to inflate the lung that was transplanted. Your chest tube will stay in place until your lung has fully inflated.
Receive many different medicines
Have
bronchoscopy -- a flexible camera used to look at your airways and make sure that the new lung is healing
The recovery period is about 6 months. Often, your transplant team will ask you to stay close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests and x-rays for many years.
Outlook (Prognosis)
A lung transplant is a major procedure that is performed for patients with life-threatening lung disease or damage.
Around four out of five people are still alive 1 year after the transplant. Around two out of five transplant recipients are alive at 5 years. Outcomes are similar for single and double lung transplants. The highest risk of death is during the first year, mainly from problems such as rejection.
Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ as an invader (much like an infection) and may attack it.
To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids). These drugs suppress the body's immune response and reduce the chance of rejection. As a result, however, these drugs also reduce the body's natural ability to fight off infections.
By 5 years after a lung transplant, at least one in five people develop cancers or have problems with the heart. These two conditions cause most deaths at 5 years.
For most people, the quality of life is improved after a lung transplant. They have better exercise endurance and are able to do more on a daily basis.
References
Smythe WR, Reznik Si, Putnam JB Jr. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 59.
Solomon M, Grasemann H, Keshavjee S. Pediatric lung transplantation. Pediatr Clin North Am. 2010; 57(2):375-391.
Flume PA, Mogayzel PJ Jr, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC; Clinical Practice Guidelines for Pulmonary Therapies Committee; Cystic Fibrosis Foundation Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: Pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med. 2010; 182(3):298-306.
Kotloff RM. Lung transplantation. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 95.
Review Date: 5/4/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Solid organ transplant - lung
Risks
Risks from any anesthesia are:
- Breathing problems
- Reactions to the medications
Risks from any surgery are:
Other risks of transplant include:
- Blood clots (deep venous thrombosis)
- Diabetes, bone thinning, or high cholesterol levels from the medications given after a transplant
- Increased risk for infections due to anti-rejection (immunosuppression) medications
- Damage to your kidneys, liver, or other organs from anti-rejection medications
- Future risk of certain cancers
Risks of lung transplant include:
Problems at the place where the new blood vessels and airways were attached
Rejection of the new lung, which may happen right away, within the first 4 to 6 weeks, or over time
References
Smythe WR, Reznik Si, Putnam JB Jr. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 59.
Solomon M, Grasemann H, Keshavjee S. Pediatric lung transplantation. Pediatr Clin North Am. 2010; 57(2):375-391.
Flume PA, Mogayzel PJ Jr, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC; Clinical Practice Guidelines for Pulmonary Therapies Committee; Cystic Fibrosis Foundation Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: Pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med. 2010; 182(3):298-306.
Kotloff RM. Lung transplantation. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 95.
Review Date: 5/4/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 5/4/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.