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Lung transplant

Lung transplant - series

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

In most cases, the new lung or lungs are usually donated by a person who is under age 65 and brain-dead, but is still on life-support. The donor tissue must be matched as closely as possible to your tissue type. This reduces the chance that the body will reject the transplant.

Lungs can also be given by living donors. Two or more people are needed. Each person donates a segment (lobe) of their lung. This forms 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 often done with the use of a heart-lung machine. This device does the work of your heart and lungs while your heart and lungs are stopped for the surgery.

After the cut is made, the major steps during lung transplant surgery include:

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

In most cases, a lung transplant is done only after all other treatments for lung failure are unsuccessful. Lung transplants may be recommended for people 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 people who:

Risks

Risks of lung transplant include:

Before the Procedure

You will have the following tests to determine if you are a good candidate for the operation:

Good candidates for transplant are put on a regional waiting list. Your place on the waiting list is based on a number of factors, including:

For most adults, the amount of time you spend on a waiting list most often does not determine how soon you get a lung. Waiting time is often at least 2 to 3 years.

While you are waiting for a new lung:

Before the procedure, always tell your provider:

Do not eat or drink anything when you are told to come to the hospital for your lung transplant. Take only the drugs that you have been told to take with a small sip of water.

After the Procedure

You should expect to stay in the hospital for 7 to 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.

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 people with life-threatening lung disease or damage.

About four out of five patients are still alive 1 year after the transplant. About two out of five transplant recipients are alive at 5 years. 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 and may attack it.

To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs. 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. 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

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. PMID: 20675678 www.ncbi.nlm.nih.gov/pubmed/20675678.

Kotloff RM, Keshavjee S. Lung transplantation. In: Broaddus VC, Mason RJ, Ernst MD, et al. Murray & Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 106.

Putnam JB. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 58.

Solomon M, Grasemann H, Keshavjee S. Pediatric lung transplantation. Pediatr Clin North Am. 2010; 57(2):375-91. PMID: 20371042 www.ncbi.nlm.nih.gov/pubmed/20371042.


Review Date: 4/13/2015
Reviewed By: Dale Mueller, MD, cardiovascular and thoracic surgeon, HeartCare Midwest; Chairman Department of Cardiovascular Medicine and Surgery, OSF St. Francis Medical Center; and Clinical Associate Professor of Surgery, University of Illinois, Peoria, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.