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What is a lung transplant?
When is a lung transplant needed?
What distinguishes the lung transplant program at University of Minnesota Medical Center?
How long is the wait for a donor lung?
How do I start the process?
How am I evaluated for a lung transplant?
What does the procedure involve?
What should I expect after transplant?
What complications can occur?
Do the anti-rejection drugs have side effects?
How can I cope with fears of rejection and other concerns?
Can I return to work and other activities?
What is heart-lung transplantation?
What is a lung transplant?
A lung transplant is a surgical procedure where one or both of your lungs are removed and replaced with the lung or lungs from an organ donor. This is a complex major operation. A transplant operation is only considered when the available medical treatment has been tried without success. Lung transplants are sometimes done in combination with a heart transplant. Until the late 1980’s, combined heart-lung transplants were the most common form of lung transplantation. Since then, isolated lung transplantation (one or two lungs) has become the most common.
Most lung transplants come from deceased donors, people who have died and donated their organs for transplants. Rarely, a partial lung transplant may come from living donors. Two living donors are needed for each recipient.
The first successful human lung transplant was performed at University of Minnesota Medical Center, Fairview in 1986. Since then, the success rates have improved steadily, and increasing numbers of lung transplants are being done to treat patients with diseases that damage the lungs severely enough to place their lives at risk.
Each year, more than 330,000 people die in the United States because of lung disease, which is the country’s third leading cause of death. Most lung diseases are chronic, and more than 30 million Americans are now living with chronic lung disease.
Today, nearly 4,000 people in the United States are waiting for a lung transplant. However, fewer than 1500 lung transplant operations were performed in this country last year. There are not enough donor lungs to allow everyone with lung disease to have a transplant.
When is a lung transplant needed?
Diseases that may be indications for lung transplants include:
- Progressive lung disease such as pulmonary fibrosis, pulmonary hypertension, occupational lung disease and bronchiolitis obliterans
- Obstructive lung diseases such as emphysema and chronic obstructive pulmonary disease (COPD)
- Inherited lung diseases such as cystic fibrosis and alpha-1 anitrypsin deficiency
Other considerations for a lung tranplant include:
- The person's chance of living two years is less than 50 percent without a transplant
- No other serious medical conditions are present that would reduce the person's life expectancy
- There is a strong expectation that a lung transplant will help the person live longer with a better quality of life
What distinguishes the lung transplant program at University of Minnesota Medical Center?
Since 1986, University of Minnesota Physicians have performed more than 650 lung and heart-lung transplants in children and adults. This makes our program one of the most active lung transplant centers in the world. University of Minnesota Physicians are leaders in using lung transplantation to reduce the impact of cystic fibrosis and other advanced lung diseases. We have pioneered many surgical and medical innovations in lung and heart/lung transplantation.
University of Minnesota Medical Center, Fairview became one of the first hospitals in the United States with a program fully dedicated to lung transplantation.
How long is the wait for a donor lung?
The length of time you spend on the waiting list may vary depending on how severe your disease is and on the availability of a well-matched donor lung. After you evaluation, we will be able to give you an estimate of your expected wait-list time.
How successful are lung transplants?
The survial rate for our lung transplant patients is significantly higher than the national average. For more information, click on this link to see our
Success Rates
.
How do I start the process?
You start the process by speaking to your doctor. If your doctor agrees that a lung transplant would be a good treatment option, you will be referred to University of Minnesota Medical Center. You will need to speak to the transplant coordinator, who will make arrangements for you to undergo a complete medical evaluation. This evaluation will help you and your health care team decide whether the transplant would be a good choice for you.
How am I evaluated for a lung transplant?
When you have life-threatening lung disease, alternative treatments may be considered and tried. If these fail, however, an evaluation for a lung transplant may be considered. Conditions that may qualify you for a lung transplant include:
- less than two years of life expectancy
- progressive disability
- severe lung disease that does not respond to any treatment
You will need to meet with a transplant surgeon and with a transplant coordinator at a
transplant center. In addition to a medical history review and physical examination, you may receive:
- An evaluation of your heart, including an EKG, echocardiogram and heart catheterization
- Pulmonary function tests including chest x-ray and CT scan
- Blood tests, including blood and tissue typing
- Social and psychological evaluations
- Dental exams
If everything goes well, you will be placed on the center’s waiting list until a suitably matched donor lung becomes available. You will also be registered on the national waiting list, which is maintained by UNOS.
What does the procedure involve?
In a lung transplant, your diseased lung (or lungs) is replaced with a healthy lung. If possible, only one lung is transplanted when a deceased donor is used—to allow the donor’s other lung to be used for another patient. In cases where your remaining lung might infect the transplanted lung, a double lung transplant may be indicated.
During a lung transplant procedure, the surgeon makes an incision in your chest, removes either one or both lungs, and transplants either one or two entire lungs. Once the lungs have been removed from the donor, the maximum preservation time before transplant begins is six hours. The lung transplant procedure usually takes four to eight hours. For single lung transplants, an incision is made on the side of the body where the lung is to be replaced; the operation takes about 4-8 hours. Double lung transplants involve an incision below the breasts and take about 6-12 hours of surgery. Once the lungs are replaced, the blood vessels and airway are attached.
What should I expect after the transplant?
If the post-operative course is a smooth one, you should be able to go home from the hospital within about two weeks after your surgery. However, if there are complications such as infection or rejection, the hospital stay will be extended. It usually takes about six months to fully recover from lung transplant surgery.
Remember that you will need to take special medicines, called immunosuppressive or anti-rejection medications, following your transplant surgery to help prevent your body from rejecting your newly transplanted organ. It is necessary to take these medications exactly as the doctor prescribes for the rest of your life.
In addition, you will have regularly scheduled outpatient tests, such as a bronchoscopy, to monitor the function of your transplanted lung and check for signs of organ rejection, and you will be encouraged to maintain a healthy lifestyle through diet and exercise.
What complications may occur?
The main complications that may occur are infection and rejection. In order to prevent rejection, it is important to take your medications faithfully, exactly as prescribed. Your transplant team will check you regularly to detect any early signs of infection or rejection. If you notice symptoms such as shortness of breath, speak to your transplant team at once. They will do additional tests to help identify the problem and plan treatment. If you notice any of the following symptoms, speak to your transplant team at once. They will do additional tests to help identify the problem and plan treatment:
- Signs of infection, including fever and chills; you are more susceptible to infections while taking immunosuppressive medications
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Increased sputum (phlegm) production
- Coughing up blood
- The surgical incision opens
- Changes in your weight or blood pressure
- New chest pain
The medications you need to take to prevent rejection lower your body's immune defenses, and this increases the chance of infection. This risk is higher right after your transplant because the doses of your medications are higher. During this time, it is important to avoid large crowds and people who are sick, especially with contagious diseases such as colds and flu. You should wash your hands often.
Do the anti-rejection medications have side effects?
Yes. These medications have many potential side effects. All of them can increase your chances of getting infections. Other side effects depend on the specific medications you are taking. It is important to learn the side effects each of your medications may cause and understand what to do if you experience any of them. Some side effects are more serious and require an immediate call to your transplant team and quick adjustments in your medications.
Other side effects may be a bother but not life threatening, and they can be dealt with at your next clinic visit. Ask your transplant team what to do to minimize side effects.
How can I cope with fears of rejection and other concerns?
Although a transplant gives you a new lease on life, with added freedom and increased energy and productivity, it is normal to experience some stress. This may include fears about rejecting the transplant, concerns about returning to work or other activities and feelings of isolation. Here are some strategies that may help you to better cope with these and other challenges:
- Join a local support group for transplant recipients.
- Learn as much as possible about your medical care and individual progress.
- Find personal quiet time to think about your feelings and concerns and the adjustments you need to make.
- Get to know the members of your transplant team, and sit down with them to discuss those issues that may most concern you.
Can I return to work and other activities?
Some patients may be able to return to their previous employment, start a new job or work part-time. If this is not possible, however, there are many other ways to feel productive. This might include continuing your education, pursuing a hobby, volunteering for your church or a local community group, starting an exercise program, or just spending quality time with family and friends. If returning to work is an option, you may find it helpful to speak to the social worker at your transplant center about the rehabilitation services provided through your state’s Department of Vocational Rehabilitation.
What is Heart-Lung Transplantation?
Heart-lung transplantation is the surgical placement of a set of heart and lungs from a deceased donor into the recipient whose own heart and lungs are badly damaged from a disease process. Like lung transplantation, heart-lung transplantation is a procedure for patients for whom there are no other medical or surgical options.
