Lung transplant

• Alpha-1-antitrypsin deficiency
• Bronchiectasis
• Chronic obstructive pulmonary disease (COPD), including emphysema
• Congenital heart disease with Eisenmenger syndrome
• Cystic fibrosis
• Interstitial lung disease
• Lymphangioleiomyomatosis (LAM)
• Pulmonary arterial hypertension
• Pulmonary fibrosis
• Sarcoidosis
• Severe bronchiectasis

Patients with serious lung diseases who meet certain criteria may be a candidate to receive a lung transplant. Lung transplantation can be considered when a patient with advanced lung disease has failed other medical or surgical therapies.

You may be considered for a lung transplant if:

• You have severe and progressive lung disease that is no longer responding to the most complete and effective treatment.
• You have a disease or condition for which transplant is considered to be effective.
• You are willing to accept the risks of surgery and the subsequent lifelong medical treatment.
• You are physically and emotionally capable of undergoing surgery and subsequent medical treatment.
• You are not using tobacco or any form of nicotine and not abusing alcohol or drugs.
• You have a reliable social support system.

Our transplant team evaluates each patient to determine whether a lung transplant may be beneficial. A comprehensive evaluation will include lung function tests, blood tests, imaging scans and other indicated studies. Specialists will screen for other serious conditions, including chronic infections, lung cancer and cardiovascular disease.

Once it is determined that you are a transplant candidate and insurance approval is received, you will be placed on the national waiting list for a lung transplant. The national transplant waitlist is managed by the United Network for Organ Sharing (UNOS). The duration of time you are on the waitlist will vary based on your blood type, height, how bad your lung disease is, etc. There is no way to know how long you will wait for a transplantation.

While you are on the waitlist:

• You will continue to be followed up in the transplant clinic on a regular basis.
• You should maintain the best health possible.
• You should inform the transplant team immediately of any change in health status or if you are admitted to the hospital.
• You need to be reachable by phone at all times.
• Your lung transplant team will provide you and your family with ongoing education about what to expect before, during, and after your lung transplant.

It is possible that you may be temporarily inactivated or permanently removed from the waitlist for one of the following reasons:

• You develop health problems that would make transplantation unsafe.
• You engage in any smoking or substance abuse.
• You request to be removed from the waitlist.
• You refuse a transplant when an organ becomes available.

Donor lungs are matched with recipients based on blood type, body size (height and weight) and the size of their lungs. When donor lungs become available, they are first offered to the patient with the highest lung allocation score (LAS), who also matches the donor’s size and blood type. When a set of lungs is offered, the lung transplant team will review the donor’s medical and social history and examine the quality of the lungs to determine if they are acceptable size and quality for your transplant.

Based on your lung disease, your overall health, and availability of donor lungs, the transplant team may decide to replace one or both of your lungs. Rarely are the lungs and the heart are replaced at the same time. This is considered when the lung disease affects both the heart and lungs and both are irreversibly damaged.

When potential donor lungs become available, a transplant coordinator will call you and instruct you to stop eating and drinking and come to the hospital as soon as possible. When you receive the call, you should arrive within four hours. You will be under the care of the lung transplant team once you arrive at the hospital. The coordinator will let you know where in the hospital to go.

When you reach your hospital room, you will be prepared for lung transplant surgery. Blood testing and imaging will occur, and you will sign the consent for the surgery after it is reviewed with you. You may need to wait a significant amount of time for the transplant team to travel to the donor’s location and evaluate the donor lungs. There is a chance the transplant will be cancelled if the surgeon who examines the donor lungs determines that they are not good quality. If this happens, you will be sent home to prepare for the next opportunity.

After it is confirmed that the surgery will proceed, you will be taken to the operating room by the anesthesiologist. The length of time required for the actual operation varies, but generally takes six to ten hours. You will have a breathing tube inserted to help you breathe. During the operation, an incision will be made across your chest for a double (bilateral) lung transplant or along the side of your chest for a single lung transplant. Your lung(s) will be removed, and new lung(s) will be placed in the chest.

Immediately after the surgery, you will be sent to the intensive care unit (ICU) to recover. You will be monitored very closely in the ICU. You will remain in the ICU until you are ready to move to a regular hospital room. On average, the hospital stay for a lung transplant is about two to four weeks. You may require a transfer to a rehabilitation facility before you go home.

A transplant coordinator will provide post-transplant education for you and your caregivers before you leave the hospital. You will also meet with the transplant pharmacist who will explain all your transplant medications. You will receive your medications before you are discharged.

After discharge, you and your primary caregiver will be required to remain in San Antonio for a minimum of three months after your transplant. You will be seen in the lung transplant clinic on a regular basis, and be required to complete outpatient pulmonary rehabilitation. During clinic visits, you will undergo regular testing to monitor your condition as well as be seen by a transplant pulmonologist. The normal patient schedule to be seen is:

• Every week up to three months after transplant
• Every month from three months to one year after transplant
• Every 3 months after the first year after transplant

Lung transplantation has the potential to extend your life and improve the quality of your life. However, it is not possible to predict how long you will live after a lung transplant. Each lung transplant center has survival statistics for its transplant programs. For transplant programs in the United States, these statistics are collected by the Scientific Registry of Transplant Recipients and are publicly available.

Two of the most common complications after lung transplant are rejection and infection. Rejection occurs when the body recognizes that the transplanted lungs are not your own, leading your immune system to try to attack the new lungs. To prevent or delay rejection, medications known as immunosuppressants or anti-rejection medications are used to suppress the immune system. Because of these anti-rejection medications, the immune system will be less able to fight infection from bacteria, viruses, and mold. You may get infected more easily, and infections can be severe. You will need to take special precautions to avoid exposure to infections and report any symptoms of infection immediately to the transplant team. Other complications may result from the stress of the surgery or medication side effects.

Discuss the potential benefits and risks of lung transplantation with your physician and care team to make health decisions that are right for you.

Include Methodist Heart and Lung Institute Heart Failure and Transplant Center, Methodist Hospital, Methodist Hospital Specialty and Transplant, Methodist Transplant Institute.