Lung Transplant

What is a lung transplant?
Why do I need a lung transplant?
What are the risks of having a lung transplant?  
How do I prepare for a lung transplant?
What happens during a lung transplant?
What happens after a lung transplant?

What is a lung transplant?

A lung transplant is surgery to replace one or both of your lungs with lungs from a donor. Lungs will be donated to you from a person who has recently passed away and was a registered organ donor.

Why do I need a lung transplant?

You may be considered for a lung transplant if you have been diagnosed with end stage lung disease and need life-saving treatment. ‘End stage’ means your lung disease is very severe; you’ve tried all other available treatments, yet they haven’t been able to help. If you have end stage lung disease, you have probably been in and out of hospital many times and have tried different treatments.

There are very specific criteria for lung transplant surgery, and not everyone who has end stage lung disease will be eligible for lung transplantation. If you meet the criteria, your medical team will help you understand what’s involved in this major surgical procedure so you can be certain that you really do want to go ahead.

You’ll be given support and guidance from a multidisciplinary team of doctors, nurses, social workers and psychologists to help you make your decision.

What are the risks of having a lung transplant?

A lung transplant can save your life when all other procedures and treatments haven’t helped, but there are serious risks to be aware of. The current survival rates in Australia are:

The specific risks associated with lung transplant surgery are:

  • Bleeding, stroke and arrhythmias – these can occur during and after surgery
  • Cancer – you may be at risk of developing some forms of cancer from medicines used to suppress the immune system
  • Complications from medicines – medicines that prevent rejection, called immune suppressants, are essential but can cause side effects, such as kidney damage; some patients may require renal dialysis
  • Donor lung rejection – when your body considers the donor lung a foreign object and doesn’t accept it
  • Infection – your immune system will be suppressed from medications to prevent organ rejection, making you more susceptible to infections
  • Ongoing complications – having a lung transplant is a life-long commitment; many complications occur due to the treatment as well as the many tests needed after transplant
  • Primary graft dysfunction – when the new lung does not function shortly after surgery due to shock or trauma or rejection.

These types of risks affect everyone individually. Some people may be more at risk than others. Your doctor will discuss all the risks with you in detail before you agree to the surgery.

If you do agree, you’ll need to sign a consent form. You are also encouraged to discuss any questions or concerns with your medical team. Remember, at any time, you have the choice to decide not to proceed with the transplant.

How do I prepare for a lung transplant?

WAITING LIST

If you decide to go ahead with lung transplant surgery, you will need to complete what’s known as ‘the work up assessment for lung transplant suitability’. This process includes many different types of tests (the work up process). Some of these tests will be done at the hospital and others will be organised by your GP or referring doctor.

During your work up, your medical team will review your medical history, test results, social history and psychological tests. Doing this helps your team to predict where and how you might need support during and after your surgery. For more information about lung transplantation, read our Transplant Information Manual.

It is important to realise that going through the work up process does not mean that you will be listed for transplant. Sometimes the work up tests and consultations may highlight problems that may mean you are not suitable for transplant due to a high risk of not having a good outcome.

When you’re approved for your surgery, you will be placed on the lung transplant waiting list and you’ll need to wait for an available donor. You may find it useful to read through our Heart and/or Lung Transplant Listing Information for Patients, Family, Carers and Friends Booklet to answer some questions once you are listed.

Waiting for your lung transplant can be a stressful time. You will always have the full support of the transplant unit’s multidisciplinary team, as well as friends and family, to help you during this challenging time. Our “Dealing with a Transplant book” is also a useful resource.

Your team will see you regularly to monitor your health, and you’ll need to keep your phone with you all the time so you can be notified when a donor becomes available.

TIME FOR TRANSPLANT

When you receive a call to come in for your lung transplant, you will need to move quickly to arrive at the hospital and be ready in time for theatre. Many calls happen after hours, but you need to be prepared to go to hospital at any time of the day or night. As soon as you know you must go to the hospital, you’ll need to begin fasting.

It’s also important that you always keep your mobile phone with you until you go into surgery. When you arrive at the hospital, you’ll be quickly prepared for surgery. This includes:

  • Blood tests
  • Chest X-rays
  • Having your chest shaved
  • Showering
  • Wearing a hospital gown
  • You will also be given some medications to prepare your body for the surgery.

Your family can stay with you until you arrive at the operating theatre, and then they’ll be asked to wait in the ICU waiting room until you come out of the theatre.

Keep in mind, you could also have one or more ‘false alarms’ – meaning your transplant doesn’t end up going ahead. A false alarm can happen if the medical team find out the donor lung isn’t suitable for you.

What happens during a lung transplant?

Your lung transplant surgery will be performed under general anaesthetic. You will be given medications before your surgery to relax and make you fall asleep. You will not be aware of what happens during the surgery. After you fall asleep, your doctor will:

  • Make an incision in your chest to open the rib cage and access your lung; the incision varies by the type of lung transplant:
    • An incision on one side of the chest only (for a single lung transplant)
    • An incision across the entire width of the front of the chest, or
    • An incision on either side (for a double lung transplant
  • Most often you will be connected to a lung bypass machine which pumps blood through your body while your lung is being operated on
  • For a double lung transplant, each of your lungs will be removed one at a time and the transplant of the donor lungs will take place one at a time
  • The large airways and blood vessels will be connected back, but the surgeon cannot connect back the nervous system during transplant surgery: This is called “denervation”
  • The surgeon will remove your diseased lung and sew the donor lung into place 
  • Chest tubes will be inserted to drain air, fluid and blood out of the chest to allow the lungs to fully re-expand
  • You will be taken off the bypass machine once the lungs are sewn in and working
  • Your surgeon will close the incisions and finish the surgery
  • Your medical team will give you immunosuppressant medications, which prevent your body from rejecting the donor lung(s), as well as antibiotics to help prevent infection.

The surgery takes four to eight hours.

What happens after a lung transplant?

After your lung transplant surgery, you will be transferred to the Intensive Care Unit (ICU), and you’ll stay there until you have recovered from your operation and become stable. When you first wake up, you may feel drowsy and you’ll have a breathing tube in your mouth. You will be given pain medication through a cannula into a vein.

Your family and support team, who will have been waiting for you in ICU, can visit you as soon as you are stable. A bronchoscopy is done by the medical team before you wake up to make sure there is no blood in the lungs and to take samples help decide what antibiotics to use.

Most people wake up within 24 hours after the operation. When you wake up, the breathing tube is removed. You will then be given small amounts of oxygen through some nasal prongs. When you’re ready to leave the ICU, you will go to a hospital room on a respiratory ward for one or two weeks. There, you’ll be seen regularly by specially trained medical and nursing staff, dietitians, pharmacists, physiotherapists and social workers.

You’ll also have regular blood tests, chest X-rays and ECGs. One week after your transplant, you will have another bronchoscopy under sedation in theatre to look inside the lungs and check your airways. If you live near the hospital, you will be able to return home on discharge from the hospital. This is usually seven to 10 days after your transplant.

Patients who live a long way from the hospital need to stay near the hospital for up to 3 months. During this time, a member family member, friend, or carer will need to stay with you. The social worker will help arrange accommodation for you which is provided by the hospital.

Your medical team will give you detailed instructions on how to recover from your surgery after you have left the hospital; this includes attending regular medical appointments, as well as outpatient rehabilitation and educational sessions. You will need to have frequent blood tests, chest x-rays, and lung function tests to monitor how your new lungs are doing.

You will also have lung biopsies after three weeks, six weeks and then three months after your lung transplant. The lung biopsies will identify if your body’s immune system is accepting your new lung. You will also be taught how to:

  • Watch for signs and symptoms to recognise rejection and infection
  • Manage your transplant medications and side effects
  • Manage your emotions and feelings
  • Exercise after your lung transplant
  • Manage a healthy diet after your lung transplant.

Recovering from lung transplant surgery requires complete commitment from you and your family or support network. You and the transplant team will work together to protect your new lung(s). This means that you need to go to all your scheduled appointments, attend a pulmonary transplant rehabilitation program, and follow the health and lifestyle advice your doctor gives you.

Following your transplant team’s advice and taking your medications, will help you be physically and socially active, return to work and have a good quality of life after your successful lung transplant.