Lung transplant is a surgical procedure aimed at replacing a diseased or failing lung with a healthy one, usually one that has been taken from a deceased donor. Lung transplant is usually reserved for those who have tried medications or other treatments but their condition has not improved sufficiently.
Depending on your medical condition, one or both of your lungs may be replaced during a lung transplant. The lungs may be transplanted along with a donor heart in some situations. While lung transplant is a major operation involving many complications, it can significantly improve your overall health and life quality.
Damaged or unhealthy lungs can make it challenging for your body to get the oxygen required for its survival. A range of diseases and conditions can cause lung damage and keep those from working properly. Following are some more common causes:
Lung damage can usually be treated with special breathing devices or with medications. However, when these measures no longer help or your lung function deteriorates to a life-threatening level, your doctor might recommend a single-lung transplant or a double-lung transplant.
Lung transplantation may not be a suitable treatment for everyone. Why you are not a suitable candidate for a lung transplant depends on a number of factors. You may not be a candidate for a lung transplant if you:
The complications associated with a lung transplant can be complex and sometimes life-threatening. The main risks associated with the procedure include infection and rejection.
Your body is defended against foreign substances by your immune system. Even if you are the best possible match with your donor, your immune system will try to attack and reject your new lungs. The risk of rejection is the highest soon after the lung transplantation procedure is done and is reduced over time. After lung transplant, your drug regimen includes immunosuppressant medications so that organ rejection can be prevented. You will have to take these anti-rejection medications lifelong.
There are many noticeable side effects associated with anti-rejection drugs. Those include unwanted hair growth or hair loss, weight gain, stomach problems, and high cholesterol. Your risk of developing new conditions or precipitating existing ones are also increased by some anti-rejection medications. These conditions include kidney damage, diabetes, cancer, osteoporosis, risk of rejection, and high blood pressure. Your immune system is suppressed by anti-rejection drugs. This makes your body more susceptible to infections, especially your lungs.
For prevention of infections, your healthcare provider may recommend that you:
Preparations for lung transplantation usually start long before the surgery to place a transplanted lung. You may start preparing for a lung transplant months, weeks, or years before a donor lung is received, depending on the waiting time for a transplant.
If you are recommended by your healthcare provider to have a lung transplant, you will be sent to a lung transplant expert for evaluation. He will review your medical history, order some tests, conduct a physical examination, and assess your mental and emotional health. Your transplant team will also discuss the risks and benefits of the transplant with you and what is expected before, during, and after the procedure.
If you are selected as a candidate for a lung transplant, the transplant centre will register you and your name on the waiting list. The number of patients who require lung transplants are far more than the number of donor lungs available. Many people, unfortunately, die waiting for a lung transplant.
Your healthcare team will closely monitor your condition and adjust your treatment plan accordingly if you are on the waiting list. You may be recommended healthy lifestyle changes like getting regular exercise, eating a healthy diet, and avoiding tobacco. You may be recommended to participate in a pulmonary rehabilitation program while you wait for a donor lung. These programs may help improve your overall health and ability to function in daily life prior to and post-transplantation.
Finding a suitable donor for your lung transplantation may take months or even years. However, you must be prepared to act quickly when the time comes. You must ensure that the transplant team knows how to contact you at all times. When the donor is found, you may be expected to reach the hospital within just a few hours. After you reach the hospital, you will have to undergo certain tests to ensure that the donor lung is a good match and that you are healthy enough to undergo the surgery.
General anaesthesia will be given for the procedure, so you won’t feel any pain during it. A tube will be guided through your mouth into your windpipe to help you breathe. A cut will be made by your surgeon in your chest so that the damaged lung can be removed. Then, the main airway to that lung and the blood vessels between the heart and the lung will be connected to the lung of the donor. For some lung-transplant procedures, you will be attached to a lung-heart bypass machine that helps circulate your blood during the procedure.
Soon after the surgery, you will need to spend several days in the intensive care unit (ICU) of the hospital. You will breathe on a mechanical ventilator for a few days, and fluids from around your heart and lungs will be drained with the help of tubes. Strong medications will be delivered to your body through the tube to control pain and prevent rejection in the new lung. As your condition improves, you won’t require the mechanical ventilator, and you will be shifted out of the ICU. You will need to stay in the hospital for a few more weeks until you recover.
After you are discharged from the hospital, you will need around three months of frequent monitoring by the lung transplant team to prevent, diagnose, and manage complications and to evaluate your lung function. You will be required to stay close to the hospital during this time. The follow-up visits are less frequent afterwards and you can travel back and forth for follow-up visits.
Your follow-up visits may involve certain laboratory tests, chest X-rays, lung function tests, an electrocardiogram (ECG), a lung biopsy and checkups with a specialist.
During a lung biopsy, the doctor removes a very small sample of your lung tissue to test for signs of infection and rejection. This test is sometimes performed as a part of bronchoscopy. The doctor inserts a small, flexible tube called a bronchoscope via the nose or the mouth into the lungs. A small camera with a light is attached to the bronchoscope to allow the doctor to visualise the inside of the airways of the lungs. The doctor may employ special tools to remove small lung tissue samples so that those can be tested in a laboratory.
You will be closely monitored by your transplant team, who will help you manage the side effects of immunosuppressant medications. Your transplant team may also monitor and treat your infections. Your doctor may prescribe some antiviral, antibacterial, or antifungal medications to help prevent infections. He will also instruct you about ways you can follow to help prevent infections at home.
You will be continuously monitored for any signs and symptoms of rejection, which can include fever, shortness of breath, chest congestion, and coughing. Informing your transplant team right away if you experience any signs of transplant rejection is extremely important.
You will be required to make long-term adjustments post lung transplant, including:
Your quality of life can be significantly improved with a lung transplant. The first year post-transplant is the most critical period as during this period, the surgical complications, infections, and rejection pose the greatest threats. Many patients have successfully survived for five to ten years after a lung transplant.
Feeling overwhelmed or anxious after a lung transplant or having fears about rejection, resuming normal activities, or other problems is normal after a transplant. You can cope with this stressful time by seeking the support of friends and family members. You can also consider:
You may need to make some adjustments to your diet to stay in good health after the transplant. Achieving and maintaining a healthy weight through diet and exercise can help you stay away from complications like heart disease, blood pressure, and diabetes. Your transplant team will also comprise a dietician who will review your nutritional needs and formulate a diet plan for you accordingly.
After the transplant, your healthcare team may recommend you to exercise and perform physical activity regularly. Your healthcare team will formulate an exercise program to help meet your needs. You will also be recommended to join a pulmonary rehabilitation program which consists of education and exercise that may improve your breathing and ability to function normally. Your team may provide education and training in many areas, including nutrition, exercise, and breathing strategies.
Your exercise program may include exercises for warm-up such as slow walking and stretching. Your treatment team may suggest physical activities like bicycling, walking, or strength training as part of your exercise program. You must discuss with your healthcare provider the activities that may be suitable for you. If you experience symptoms like dizziness or shortness of breath, you must stop exercising and consult your doctor.
The Department of Pulmonary Medicine at Kokilaben Dhirubhai Ambani Hospital, Indore offers comprehensive diagnostic and therapeutic care for a diverse range of pulmonological diseases. Our services include endoscopic ultrasound, endo bronchial ultrasound, endobronchial brachytherapy, innovative therapeutic techniques, bronchial thermoplasty and surgical interventions like video-assisted thoracoscopic surgery and lung volume reduction. We also offer treatment for sleep disorders, lung cancers, and lung transplantation. Consult our pulmonologists and specialists who offer the best lung transplant services in Indore. We follow an evidence-based approach during all our services to ensure the best possible lung transplant success rates. Our focus is on ensuring the speedy recovery of the patient and helping him return to normal activities of daily life as soon as possible.