Lung transplant

Definition 
Lung transplant is surgery to replace one or both diseased lungs with healthy lungs from a human donor.

Description 

A lung transplant is usually the last resort treatment for lung failure. The new lung or lungs are donated by someone who has been declared brain-dead but remains on life-support.

The donor tissue must be matched as closely as possible to that of the recipient to reduce the odds that the transplanted tissue will be rejected.

While the recipient is unconscious and pain-free (general anesthesia), an incision is made in the chest. Tubes are used to re-route blood to a heart-lung bypass machine to provide oxygen and circulation during the surgery.

One or both of the patient’s lungs are removed, and the donor lung or lungs are stitched (sutured) into place. Chest tubes are inserted to drain air, fluid, and blood out of the chest for several days to allow the lungs to fully re-expand.

Sometimes heart and lung transplantation are performed at the same time (heart-lung transplant), if the patient’s heart is also diseased.

Indications 
Lung transplants may be recommended for patients with any severe lung disease. Some examples of disease that may require lung transplant are:

     
  • permanent enlargement of air sacs (alveoli) with loss of ability to completely exhale (emphysema)  
  • hereditary lung blockages (cystic fibrosis)  
  • long-term (chronic) inflammation (sarcoidosis)  
  • permanent scarring and thickening of lung tissue (idiopathic pulmonary fibrosis)

Lung transplant is not recommended for patients with serious illnesses, such as reduced kidney or liver function, or other serious diseases.

Risks 
Risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

Risks for any surgery are:

     
  • bleeding  
  • infection

Additional risks of transplant includes:

Expectations after surgery 
Lung transplant is an extreme measure for patients with life-threatening lung disease or damage. Current survival rates are as high as 80% at 1 year following transplantation and 60% at 4 years.

Fighting rejection is an ongoing process. The body’s immune system considers the transplanted organ as an invader (much like an infection) and may attack it. To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids) that suppress the body’s immune response and reduce the chance of rejection. As a result, however, these drugs also reduce the body’s natural ability to fight off various infections.

Convalescence 
An extended hospital stay should be expected. The recovery period is about 6 months. Frequent check-ups with blood tests and x-ray tests will be necessary for years.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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