What is Lung Transplant? Purpose, Procedure & Results

A lung transplant is a surgical procedure where doctors replace one or both of your diseased lungs with healthy lungs from a donor. This life-saving treatment becomes an option when your lungs are so severely damaged that other treatments can't help you breathe well enough to live comfortably.

Think of it as giving your body a fresh start with healthy lungs when your own can no longer do their job. While it sounds overwhelming, lung transplants have helped thousands of people return to activities they love and spend precious time with family.

What is a lung transplant?

A lung transplant involves surgically removing your damaged lung or lungs and replacing them with healthy ones from someone who has died and chosen to be an organ donor. The new lungs come from donors whose lungs are healthy and compatible with your body.

There are three main types of lung transplants. A single lung transplant replaces one lung and works well for certain conditions like pulmonary fibrosis. A double lung transplant replaces both lungs and is often needed for diseases like cystic fibrosis. Sometimes, doctors perform a heart-lung transplant when both organs need replacement.

The decision about which type you need depends on your specific condition and how it affects your breathing. Your transplant team will carefully evaluate your situation to recommend the best approach for your health.

Why is lung transplant done?

Lung transplants are recommended when your lung disease has progressed to the point where you can't get enough oxygen, even with the best medical treatments available. This usually happens when your lungs are so scarred or damaged that they can't expand properly or exchange oxygen effectively.

Several serious lung conditions can lead to transplant consideration, and understanding these can help you see why this treatment becomes necessary:

• Chronic obstructive pulmonary disease (COPD), which makes breathing increasingly difficult over time
• Idiopathic pulmonary fibrosis, where lung tissue becomes thick and scarred for unknown reasons
• Cystic fibrosis, a genetic condition that causes thick mucus to build up in the lungs
• Alpha-1 antitrypsin deficiency, where a missing protein leads to lung damage
• Pulmonary hypertension, which puts dangerous pressure on blood vessels in your lungs
• Sarcoidosis, an inflammatory disease that can severely scar lung tissue

Your doctor will only recommend transplant when they've exhausted other treatment options. This means you've tried medications, oxygen therapy, pulmonary rehabilitation, and any other treatments specific to your condition without sufficient improvement.

What is the procedure for lung transplant?

The lung transplant procedure typically takes 4 to 12 hours, depending on whether you're receiving one or both lungs. Your surgical team will put you under general anesthesia, so you'll be completely asleep throughout the entire operation.

Here's what happens during the surgery, broken down into manageable steps:

1. Your surgeon makes an incision in your chest to access your lungs
2. They carefully disconnect your damaged lung from the blood vessels and breathing tubes
3. The diseased lung is removed and the donor lung is positioned in the same space
4. Your surgeon connects the new lung to your blood vessels and main breathing tube
5. They test the connections to ensure blood flows properly and air moves freely
6. The incision is closed with sutures, and you're moved to intensive care for monitoring

During the surgery, you might be connected to a heart-lung machine that does the work of your heart and lungs while the surgeon operates. This keeps oxygen flowing to your body and removes carbon dioxide safely.

The surgical team includes specialists in lung transplantation, anesthesia, and intensive care. They work together to ensure every step goes smoothly and your body adjusts well to the new lung.

How to prepare for your lung transplant?

Preparing for a lung transplant involves both physical and emotional preparation that can take several months. Your transplant team will guide you through each step to ensure you're as healthy as possible before surgery.

The preparation process includes several important medical evaluations:

• Comprehensive blood tests to check your overall health and organ function
• Heart tests like echocardiograms to ensure your heart can handle the surgery
• CT scans and chest X-rays to map out your lung damage precisely
• Pulmonary function tests to measure how well your current lungs work
• Psychological evaluation to assess your mental readiness and support system
• Dental examination to treat any infections that could complicate recovery

Your healthcare team will also review your medications and may adjust them before surgery. Some medications can interfere with the transplant process or interact with the immunosuppressive drugs you'll need afterward.

Physical preparation often includes pulmonary rehabilitation to keep your muscles as strong as possible. Even though your lungs aren't working well, staying active within your limits helps your body prepare for the recovery ahead.

How to read your lung transplant results?

After your lung transplant, your medical team will monitor several key indicators to assess how well your new lungs are working. These measurements help doctors catch any problems early and adjust your treatment as needed.

Your breathing tests will show significant improvements compared to before your transplant. Pulmonary function tests measure how much air you can breathe in and out, and these numbers typically improve dramatically within weeks of successful transplant surgery.

Blood tests become a regular part of your life after transplant, checking several important factors:

• Oxygen levels in your blood, which should be much higher than before surgery
• Immunosuppressive drug levels to prevent rejection while avoiding side effects
• Signs of infection, since your immune system will be deliberately weakened
• Kidney and liver function, as some medications can affect these organs
• Complete blood counts to monitor for medication side effects

Your doctor will also perform regular biopsies, especially in the first year. These involve taking tiny samples of lung tissue to check for rejection, which happens when your immune system tries to attack the new lung.

Chest X-rays and CT scans help your team see how your lungs look and function. Clear, well-expanded lungs on imaging studies are excellent signs that your transplant is working well.

How to maintain your lung transplant health?

Taking care of your new lungs requires lifelong commitment to medications and healthy habits. The most important step is taking your immunosuppressive medications exactly as prescribed, even when you feel perfectly healthy.

These anti-rejection medications prevent your immune system from attacking your new lungs. Missing doses or stopping them can lead to rejection, which can be life-threatening. Your doctor will regularly adjust these medications based on your blood levels and how you're feeling.

Protecting yourself from infections becomes a top priority since your immune system is intentionally weakened:

• Wash your hands frequently and thoroughly, especially before eating or touching your face
• Avoid crowds during cold and flu season or wear a mask in public spaces
• Stay up to date with vaccinations, but avoid live vaccines as they can be dangerous
• Practice good food safety by avoiding raw or undercooked foods
• Keep your living space clean and avoid exposure to mold or dust

Regular exercise helps maintain your strength and lung function. Your transplant team will create a safe exercise plan that gradually builds your endurance without overexerting your new lungs.

Following up with your transplant team regularly is essential. These appointments allow doctors to catch any problems early and adjust your care as needed.

What are the risk factors for lung transplant complications?

Several factors can increase your risk of complications after lung transplant. Understanding these helps you and your medical team take extra precautions to protect your health.

Age plays a role in transplant success, though it's not the only factor. Older recipients may have a higher risk of complications, but many people over 65 have successful transplants with proper care and monitoring.

Your overall health before transplant significantly affects your outcome. People with multiple organ problems, severe malnutrition, or poor muscle strength face higher risks during and after surgery.

Specific risk factors that require extra attention include:

• Previous chest surgeries that create scar tissue and make the operation more complex
• Diabetes, which can slow healing and increase infection risk
• Kidney disease, as some anti-rejection medications can further damage kidneys
• Osteoporosis, since immunosuppressive drugs can weaken bones
• History of cancer, which may return due to weakened immune system
• Poor social support, as you'll need help with daily activities during recovery

Your mental health also affects transplant success. Depression, anxiety, or substance abuse can interfere with medication compliance and self-care, leading to complications.

Having said that, many people with risk factors still have successful transplants. Your transplant team will work with you to minimize these risks and optimize your chances of a good outcome.

What are the possible complications of lung transplant?

Lung transplant complications can occur immediately after surgery or develop months to years later. While this sounds concerning, understanding these possibilities helps you recognize warning signs and seek prompt treatment.

Immediate surgical complications can include bleeding, infection at the surgical site, or problems with the connections between your new lung and your blood vessels. These are relatively rare but require immediate medical attention when they occur.

Long-term complications tend to be more common and require ongoing management throughout your life:

• Chronic rejection, where your immune system slowly damages the new lung over time
• Increased risk of infections due to immunosuppressive medications
• Higher chance of developing certain cancers, especially skin cancer
• Kidney problems from long-term use of anti-rejection medications
• Bone disease and fractures due to steroid medications
• High blood pressure and diabetes as side effects of immunosuppressive drugs

Bronchiolitis obliterans syndrome is a specific type of chronic rejection that affects the small airways in your lungs. It can cause gradual breathing difficulties and may require changes in your medications or additional treatments.

The risk of developing lymphoma, a type of blood cancer, is higher in transplant recipients. This happens because the medications that prevent rejection also make it harder for your body to fight off cancer cells.

Despite these risks, many people live full, active lives for many years after transplant. Regular monitoring and prompt treatment of complications can help minimize their impact on your daily life.

When should I see a doctor after lung transplant?

You should contact your transplant team immediately if you experience any signs that might indicate rejection or infection. These symptoms can develop quickly and require urgent evaluation and treatment.

Call your doctor right away if you notice any breathing changes, such as increased shortness of breath, decreased exercise tolerance, or the need for more oxygen than usual. These could be early signs of rejection or infection.

Other warning signs that require immediate medical attention include:

• Fever above 100.4°F (38°C), which may indicate an infection
• New or worsening cough, especially if you're coughing up blood or colored sputum
• Chest pain or tightness that doesn't improve with rest
• Swelling in your legs, ankles, or abdomen
• Significant weight gain over a few days
• Severe fatigue or weakness that interferes with daily activities

Changes in your mental state, such as confusion, severe mood changes, or difficulty concentrating, can also indicate serious complications and warrant immediate evaluation.

Don't wait to see if symptoms improve on their own. Early treatment of complications leads to better outcomes and can prevent minor problems from becoming serious ones.