Lung Transplant

A lung transplant is a major surgical procedure that can greatly improve health and quality of life for people with end-stage lung disease when other treatments have stopped working.

Table of contents

• What Is a Lung Transplant?
• Conditions That May Require a Lung Transplant
• Types of Lung Transplant
• Who Can Have a Lung Transplant?
• The Evaluation Process
• The Transplant Waiting List
• The Transplant Surgery
• Recovery and Hospital Stay
• Life After Lung Transplant
• Medications After Transplant
• Staying Healthy After Transplant
• Success Rates and Outcomes

What Is a Lung Transplant?

A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy lung from a donor^[1]. Most donated lungs come from people who have died (deceased donors)^[2]. During the surgery, surgeons remove your diseased lung and then attach a donor lung to your airway and to the blood vessels that lead to and from your heart^[1].

A lung transplant is reserved for people who have tried medications or other treatments, but their conditions haven’t improved enough^[1]. This procedure is considered when you have a serious lung condition that doesn’t respond to medications and other treatments^[2].

While a lung transplant is a major operation that can involve many complications, it can greatly improve your health and quality of life^[1]. Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure^[11].

Conditions That May Require a Lung Transplant

Unhealthy or damaged lungs can make it difficult for your body to get the oxygen it needs to survive^[1]. A variety of diseases and conditions can damage your lungs and keep them from functioning effectively.

Some of the more common causes that may require a lung transplant include^[1]:

• Chronic obstructive pulmonary disease (COPD), including emphysema
• Scarring of the lungs (pulmonary fibrosis)
• Cystic fibrosis
• High blood pressure in the lungs (pulmonary hypertension)

Other conditions that may be treated with lung transplantation include^[2]:

• Bronchiectasis
• COVID-19 related lung damage
• Interstitial lung disease
• Lung injuries

Types of Lung Transplant

There are three main types of lung transplant^[2]:

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. Most patients replace both lungs in a transplant surgery^[5].

Heart-lung transplant: Your healthcare providers will remove your heart and both of your lungs and replace them with a donated heart and lungs. In some situations, the lungs may be transplanted along with a donor heart^[1].

Who Can Have a Lung Transplant?

In general, you’re a good candidate for a lung transplant if^[2]:

• 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

Anyone from newborn to adult can have a lung transplant^[5]. Some guidelines say lung transplant patients should be younger than 65, though many patients over 65 do have lung transplants. Usually, patients over 75 do not qualify, but transplant centers make the final decisions^[5].

The Evaluation Process

Before a lung transplant, you must go through a thorough pre-transplant screening^[2]. This 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.

The evaluation process includes many appointments and tests to evaluate your lung and general health^[16]. This information includes^[2]:

• 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

The transplant team can include a lung doctor (pulmonologist), transplant surgeon, nurse coordinator, social worker, psychologist, psychiatrist, pharmacist, dietician, and financial coordinator^[16]. After your pre-transplant screening, your transplant coordinator and other members of your lung transplant team will meet to evaluate your tests and discuss whether a lung transplant is the best treatment^[2].

The Transplant Waiting List

A patient is put on the transplant waitlist when their transplant team decides they meet requirements for lung transplant^[5]. More people need a lung transplant than there are transplantable lungs available. Several hundred people die each year while waiting for a lung transplant^[2].

The treatment team gives the patient a Lung Allocation Score (LAS) to predict how long the patient can live without a lung transplant and might live after lung transplant surgery^[5]. A higher LAS score means the patient is higher on the lung transplant waitlist, so they will get a lung transplant sooner.

Transplant surgeons only have four to six hours to complete the operation after they receive donor lungs^[19]. While you wait for your lung transplant, you will need to stay close by and be available, as you will not know when you will get the call to have your transplant^[19].

Transplant centers use ex-vivo lung perfusion (EVLP), which is technology that circulates a solution (nutrients, proteins, and oxygen) through donor lungs to evaluate their health, improve their health, and reverse lung damage^[5]. This allows transplant centers to have more donor lungs they can use for transplant.

The Transplant Surgery

During a lung transplant, surgeons remove your diseased lung and then attach a donor lung to your airway and to the blood vessels that lead to and from your heart^[1]. The surgery is a complex procedure that requires meticulous coordination among a diverse interprofessional healthcare team, including pulmonologists, cardiothoracic surgeons, anesthesiologists, intensivists, perfusionists, psychologists, social workers, nurses, and other allied health professionals^[4].

Recovery and Hospital Stay

Immediately after surgery, you’ll move to the intensive care unit (ICU)^[20]. Doctors will place you on a ventilator to help you breathe until you’re strong enough to breathe on your own. You’ll begin taking immunosuppressant drugs to keep your immune system from fighting your new lung(s). These drugs are anti-rejection drugs.

Doctors will move you to a regular patient room once you’ve gained strength^[20]. You’ll spend about three weeks:

• Seeing your transplant team to make sure your lungs are functioning
• Making sure you are healing and aren’t developing any infections
• Moving around to encourage air to flow in your lungs

You may also begin specialty therapy services. If you’re having any trouble speaking or swallowing, you may see a therapist to help you regain function. You’ll also begin breathing therapy (pulmonary rehabilitation) and physical therapy to help you get stronger^[20].

Life After Lung Transplant

After returning home, you want to resume normal living^[18]. If you want to go to a movie or a social occasion and feel up to it, you should do it. If you’d like to have friends visit you at home, that’s OK too. Try as much as possible to return to your normal routine. However, the key is moderation and understanding your limits.

Initially, you will probably have less energy than you did before surgery^[18]. It takes time for your body to heal and adjust to your new medications. Napping and pacing your activities is recommended to prevent placing a strain on your recovery.

After leaving the hospital, you should^[20]:

• Always have a caregiver with you for the first few months
• Take all medications and follow your doctors’ instructions
• Avoid driving for about four weeks until the incision has healed
• Stay away from crowds and people who are sick
• Keep your incision clean and watch for fever, redness, swelling, or trouble breathing
• Follow the eating plan your nutritionist creates for you

Plan to stay close to the transplant center — within two hours — for at least two to three months after your surgery^[20]. After your transplant, your care team will need to see you frequently during the first few weeks and months. It is very important for providers to keep a close eye on how your new lungs are functioning^[19].

You should be able to return to school or work within 3-6 months^[18]. Your transplant team will help you decide what is best for you. Many people return to a good quality of life within three to six months^[2].

Medications After Transplant

After your lung transplant, you will need to take medications for the rest of your life^[9]. The most important medications are immunosuppressant drugs (also called anti-rejection drugs). These medications help prevent your immune system from attacking and rejecting your new lung.

You must take these medications exactly as prescribed. The medications we prescribe can cause tremors, weakness, and blurred vision, and these side effects are often worse in the first few months^[18].

Staying Healthy After Transplant

Exercise will become an important part of your life, enabling a faster return to your routine activities and helping you maintain overall improved health^[18]. Exercise has been shown to improve muscle tone, as well as the functioning of your heart and lungs. It also helps reduce stress and achieve and maintain ideal body weight.

When you return home, it is recommended that you exercise daily^[18]. Walking 15-20 minutes daily and gradually increasing time as tolerated is suggested. Do not resume workouts with heavy weights until you have been cleared to do so by the transplant team.

It’s going to be challenging, but you need to be active before you have your surgery^[14]. You need to be as strong as possible and in as good physical condition as you can be prior to your transplant. This will actually make your post-operative physical therapy and occupational therapy easier.

Many people experience weight gain after a transplant because of the medications they need to take and because they are not working as hard to breathe^[14]. You can partner with a dietitian to develop a nutritional plan that meets your needs and your tastes and helps you get to and stay at a healthy weight.

You must stop using all smoking products, including cigarettes, cigars, vapes, e-cigarettes, hookahs, and cannabis in smoked form^[16]. You and the lung transplant patient can be removed from the transplant waitlist if drug tests show any amount of nicotine, tobacco, or illegal drugs (even from secondhand smoke).

Regarding pets, no birds should be kept in your house, as their droppings may cause lung infection^[18]. Cats should be declawed, and you may not change their litter.

Success Rates and Outcomes

According to the United States Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients, the survival rates for lung transplant recipients are 85% at 1 year, 68% at 3 years, and 55% at 5 years^[4].

According to the Scientific Registry of Transplant Recipients, more than 30% of lung transplant recipients survived 10 years after surgery^[20]. Recovery and long-term health outcomes are different for each person, but there’s plenty you can do to take good care of yourself and help keep your new lungs healthy.

In 2019, healthcare providers performed about 2,500 lung transplants^[2]. However, more people need a lung transplant than are transplantable lungs available. Lung transplant providers are working very hard to increase the number of lungs that can be transplanted to address this need.

The field of lung transplantation has continually evolved, increasing both in application and success^[4]. Innovations such as ex vivo lung perfusion and advancements in immunosuppressive therapies continue to improve the success rates and longevity of lung transplants. The field continues progressing and enhancing the quality of life for patients with end-stage respiratory failure.