A lung transplant is an effective treatment for disease that has destroyed most of the lungs’ function. For people with severe lung disease, a transplant can bring back easier breathing and provide years of life. However, lung transplant surgery has major risks and complications are common.
Who May Need a Lung Transplant?
Most people with severe, end-stage lung disease can be considered for a lung transplant. The procedure should be considered when someone seems likely to die without the surgery and no other options are available. A lung transplant can also be considered in people whose lung disease is so severe that they can no longer enjoy life.
The most common lung diseases for which people undergo lung transplant are:
- Chronic obstructive pulmonary disease (emphysema and chronic bronchitis)
- Idiopathic pulmonary fibrosis
- Cystic fibrosis
- Idiopathic pulmonary arterial hypertension
Among people with these conditions, lung transplant reasons can vary. For example, in emphysema, lung tissue is destroyed by smoking; in idiopathic pulmonary fibrosis, scar tissue replaces healthy lung.
Lung transplant centers may hesitate when considering people over age 60 or 65 for lung transplant.
Preparing for a Lung Transplant
The evaluation process for a lung transplant is usually long and complicated. First, a doctor refers a patient to a regional transplant center. At the transplant center, doctors, psychologists, social workers, and other staff meet with the person to gather information. This may take place on several visits occurring over many weeks or months.
Besides the patient’s lung condition, the team considers the person’s family and social support, financial situation, psychological makeup, and any other medical conditions. Numerous tests are performed during a lung transplant evaluation, which can include:
- Pulmonary function tests
- Cardiac stress test
- Coronary artery catheterization
- Bone mineral density test
- Chest X-ray
- Computed tomography (CT scan) of the chest
- Blood tests for kidney function and liver function, and a complete blood count (CBC)
- Blood type and antibodies present in the blood, for matching against potential organ donors
Doctors usually won't recommend a lung transplant if these conditions are present: significant heart, liver, or kidney disease; alcohol or drug abuse; ongoing infections; or cancer (although if there's significant heart disease, some patients may be considered for a combined heart-lung transplant). Also, anyone who continues to smoke cannot receive a lung transplant.
Going on the Lung Transplant List
After testing and interviews have been completed and it’s concluded the patient is a good candidate for a lung transplant, he or she will be listed on regional and national organ recipient lists. A person’s place on the list is determined by the Lung Allocation Score, a complicated calculation that tries to predict two things:
- How long a patient is likely to live without a lung transplant
- How long a patient would be expected to live after receiving a lung transplant
People with higher scores are considered first when organ donors’ lungs become available.
What Happens During a Lung Transplant
When a compatible donor’s lungs become available, the transplant candidate will be called urgently to the transplant center to prepare for the surgery. Members of the surgical team travel to examine the deceased donor’s lungs to make sure they are suitable for transplant. If they are, surgery on the recipient begins immediately, while the lungs are in transit to the center.
Surgeons may perform either a single lung transplant or a double lung transplant. There are advantages and disadvantages to each option, and the choice varies with the recipient’s lung disease and other factors.
A surgeon will make a large incision in the chest during a lung transplant. 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)
Complete unconsciousness is maintained with general anesthesia during the surgery. Some people receiving a lung transplant will need to go on cardiopulmonary bypass during the surgery. While on bypass, the blood is pumped and enriched with oxygen by a machine, rather than by the heart and lungs.
After a Lung Transplant
The time to full recovery after a lung transplant varies widely between people. Some people may leave the hospital within a week. However, it’s not that unusual to be in the hospital for two weeks or longer after lung transplant surgery.
The weeks after lung transplant are busy, filled with activities intended to ensure long-term success. These include:
- Regular physical therapy and rehabilitation exercises
- Education sessions to learn a complicated new lifelong medication plan
- Frequent visits to the doctor
- Regular tests of lung function, chest X-rays, blood tests, and procedures like bronchoscopy
Many transplant centers offer temporary housing nearby for patients and their families to make the frequent visits easier.
Lung Transplant Prognosis
A lung transplant can take away breathlessness and make possible an active lifestyle that can last for years. For many people, a lung transplant is nothing less than lifesaving.
After recovering from lung transplant surgery, more than 80% of people say they have no limitations on their physical activity. Among people surviving five years or more, up to 40% continue to work at least part time.
However, eventual complications after lung transplant are inevitable. The immune system’s rejection of the donor lungs can be slowed, but not stopped entirely. Also, the necessary powerful immune-suppressing drugs have unavoidable side effects, including diabetes, kidney damage, and vulnerability to infections.
For these reasons, long-term survival after a lung transplant is not as promising as it is after other organ transplants, like kidney or liver.
Still, more than 80% of people survive at least one year after lung transplant. After three years, between 55% and 70% of those receiving lung transplants are alive. Age at the time of transplant is the most important factor influencing lung transplant survival.