Lung Transplant Symptoms, Risk Factors, Diagnosis and Treatment | Narayana Health

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Lung Transplant:

A Guide to the Procedure, Risks and Recovery



What is a Lung Transplant?

A lung transplant is a surgical procedure carried out to replace a dysfunctioning and diseased lung with a healthy lung. For individuals with severe respiratory organ illness, a lung transplant procedure can bring back easier respiration and supply years of life. However, lung transplant surgery comes with some significant risks and it is essential that you read and understand the risks involved and consult a lung surgeon if a lung transplant is right for you.



When is a Lung Transplant done?

p>Most people with severe, end-stage lung diseases are thought to be ideal for a lung transplant. The procedure needs to be carried out once someone appears seemingly to die without the surgery and have no other choices. A lung transplant may also be thought of in individuals whose lung disease is so severe that it is debilitating to their lifestyle.

The most common respiratory organ diseases that require a lung transplant are:

  • Chronic obstructive pulmonary disease (emphysema and chronic bronchitis)
  • Idiopathic pulmonary fibrosis
  • Cystic fibrosis
  • Idiopathic pulmonary arterial hypertension

Among individuals with these conditions, respiratory organ transplant reasons will vary. For example, in respiratory illness, lung tissue is destroyed by smoking; in idiopathic pulmonary fibrosis, connective tissues replace the healthy respiratory organs.



Understanding Associated Risks

Risks of Lung Transplant

A lung transplant is a major surgery which comes with many risks. Before the surgery, your doctor ought to consult with you whether or not the risks related to the procedure outweigh the advantages. You should also talk about what you can do to reduce the risks. The rejection is the major risk for a lung transplant organ. This happens once your system attacks your donor lung as if it were an illness. Severe rejection can lead to the failure of the donated lung. Other serious complications may arise from the medicine accustomed to stop rejection. These are referred to as “immunosuppressants.” They work by lowering your immune response, making it less likely that your body will attack the new “foreign” lung. Immunosuppressants raise your risk of infections since your body’s “guard” is down.

Other risks of lung transplant surgery from the medicines you need to take afterwards include:

  • bleeding and blood clots
  • cancer and malignancies due to immunosuppressants
  • diabetes
  • kidney damage
  • stomach problems
  • thinning of your bones (osteoporosis)

It’s important to follow your doctor’s instructions before and after your surgery. This can help decrease your risks. Some of the instructions can include making healthy lifestyle decisions, like adopting a healthy diet and avoiding smoking. You should also try not to miss any doses of medications.



Lung Transplant Criteria and Requirements

The evaluation process for a lung transplant is typically long and complex. First of all, the doctor refers the patient to a regional transplant centre. At the transplant centre, doctors meet with the person to gather information. This may happen on many visits over several weeks or months.

Besides the patient’s lung condition, the doctor looks into the person’s family support, financial conditions, psychological makeup, and any other medical situations. Numerous tests are performed throughout a lung transplant analysis, which can include:

  • Pulmonary function tests
  • Cardiac stress test
  • Coronary artery catheterisation
  • Bone mineral density test
  • Chest X-ray
  • Computed tomography (CT scan) of the chest
  • Blood tests for kidney and liver function, and a complete blood count (CBC)
  • Blood type and antibodies present within the blood, for matching against potential organ donors

Doctors sometimes will not advocate a lung transplant if conditions such as vital heart, liver, or kidney disease; alcohol or drug abuse; ongoing infections; or cancer (although if there's significant heart sickness, some patients may be considered for a combined heart-lung transplant) are present. Also, an individual who continues to smoke cannot receive a lung transplant.



Finding a Donor

After the completion of tests and interviews, if the patient is found to be a suitable candidate for lung transplant, then his/her name is listed on the region and national organ recipient list.

The Lung Allocation Score puts the individual's place on the list, which considers a sophisticated calculation that tries to predict 2 things:

  • How long a patient is probably going to live without a lung transplant
  • How long a patient would be expected to live once receiving a lung transplant

People with higher scores are considered initially when organ donors lungs become accessible.



The Lung Transplant procedure

What Happens During a Lung Transplant

When a compatible donor’s lungs become accessible, the transplant candidate is referred to as urgently to the transplant centre to organise for the surgery. Members of the surgical team examine the deceased donor’s lungs to make sure they're appropriate for transplant. If they're, the surgery on the recipient begins immediately, while the lungs are in transit to the centre.

Doctors may perform either one lung transplant or a double lung transplant. There are benefits and drawbacks to every possibility, and the choice varies depending on the recipient’s lung disease and other factors. An operating surgeon can create an oversized incision within the chest throughout a lung transplant. The incision varies by the sort of lung transplant:

  • An incision on one side of the chest solely (for one lung transplant)
  • An incision across the complete breadth of the front of the chest, or an incision on either side (for a double lung transplant)

Complete unconsciousness is maintained with anaesthesia throughout the surgery. Some individuals receiving a lung transplant will have to be compelled to maintain cardiopulmonary bypass throughout the surgery. While on bypass, the blood is pumped-up and enriched with gas by a machine, instead of by the heart and lungs.

After a Lung Transplant

The time to fully recover from a lung transplant varies widely between individuals. Some individuals might leave the hospital at intervals every week. However, it’s not that uncommon to be within the hospital for 2 weeks or longer once the lung transplant surgery is completed.

The weeks after lung transplant is busy, crammed with activities meant to make sure of the long-run success of the operation.

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 for the function of the lung, chest X-rays, blood tests, and procedures like bronchoscopy

Many transplant centres offer temporary housing nearby for patients and their families to make frequent visits easier.



Prognosis and Outlook after Lung Transplant

Risks of Lung Transplant

A lung transplant will exclude dyspnea and change a lively lifestyle which will last for years. For many individuals, a lung transplant is nothing but lifesaving. After recovery from a lung transplant surgery, around eightieth of individuals say they need no limitations on their physical activity. Among individuals living 5 years or additional, up to four-hundredth still work on at least part-time. However, eventual complications after lung transplant are inevitable. The immune system’s rejection of the donor's lungs can be slowed, but not stopped entirely. Also, the required powerful immune-suppressing medicines have side effects such as diabetes, kidney injury, and vulnerability to infections.

For these specific reasons, lasting survival after a lung transplant is not as promising as it is after other organ transplants, like kidney or liver. Still, around eightieth of individuals survive a minimum of one year once a lung transplant is done. After 3 years, between 55% and 70% of those receiving lung transplants are alive. Age at the time of transplant is the most vital factor influencing lung transplant survival.



Precautions to Take after the Procedure

You can expect to remain in the ICU for a few days after the procedure. Your vital signs will be required to be closely monitored. You’ll likely be hooked up to a mechanical ventilator to help you breathe. Tubes will be connected to your chest to empty any fluid buildup. Your entire stay in the hospital may last weeks, but it may be shorter. How long you can stay will depend on how soon you recover.

Over the next 3 months, you'll have regular appointments with your lung transplant team. The doctors will monitor any signs of infection, rejection, or other problems. You’ll be required to live close to the transplant centre. Before you are allowed to leave the hospital, you’ll be given instructions on how to care for your surgical wound. You’ll even be told about any restrictions on medication.

Most probably, your medications will include one or more types of immunosuppressants such as:

  • cyclosporine
  • tacrolimus
  • mycophenolate mofetil
  • prednisone
  • azathioprine
  • sirolimus
  • daclizumab
  • basiliximab
  • muromonab-CD3 (Orthoclone OKT3)

Immunosuppressants are important after your transplant since they help stop your body from being offensive to your new lung. You’ll be required to take these medications for the remaining period of your life.

However, they leave you receptive to infections and alternative issues. Make sure to talk to your doctor about all the possible side effects.

You may also be given:

  • antifungal medication
  • antiviral medication
  • antibiotics
  • diuretics
  • anti-ulcer medication



Road to Recovery and Aftercare

After a lung transplant, you'll step by step begin to feel stronger. The final goal is for you to live without requiring external oxygen. Making sure your body accepts the new lungs is important to your success and recovery.

Post-Lung Transplant Recovery Process

The first few months after a lung transplant surgery are when you have the highest risk of infection or rejection. That's why you will need to remain within one hour of the hospital for at least two to three months after discharge or as directed by your transplant team. You must also have a caregiver with you at all times during these first few months. You and your caregiver should arrange for a house, which is not a medical facility, close to the hospital till you can come home. You’ll also need to monitor the site of the incision to avoid chances of any infections. Follow the directions shown by your transplant nurse before leaving the hospital.

Lung Transplant Follow-up Appointments

At first, you'll have frequent follow-up visits so that the lung transplant team can be sure that you are healing properly. After that, you will return to the hospital's post-transplant clinic at least every 2 months for a 2-day visit for the first year. This will vary based mostly upon testing results at any visit.

Preventing Lung Transplant Complications, Rejection, and Infection

Lung biopsy is the sole approach for your doctor to work out whether or not your body is accepting or rejecting the new lung or lungs. That's why it's so important that you come to all your follow-up appointments.

During these visits, you will have:

  • Pulmonary Function Tests (PFT) to make sure your new lung or lungs still improve
  • Blood work
  • Chest X-rays
  • Clinic visits
  • Bronchoscopy with biopsy/li>

You’ll need to continue with the anti-rejection drugs throughout your life. Your doctor will monitor how you respond to them and make adjustments if required. Anti-rejection drugs make you more susceptible to developing infections. After a lung transplant surgery, limit your exposure to people with sickness or places where people are contagious.

In case you feel you have any signs of infection including a fever over 100.4°, chills, swelling, redness, or fluid draining from the incision site, you can reach out to us.



Post-Lung Transplant Aftercare

Being a caregiver is a big responsibility. You may want over one person to assist you for the primary few months once your lung transplant is done.

A lung transplant caregiver will:

  • Make sure you take medications in the right doses at the right time.
  • Help you record all the information that the lung transplant team requested.
  • Drive you to and from your appointments.
  • Look for signs of unusual behaviour and contact your hospital lung transplant coordinator if anything seems wrong.
  • Shop for food and prepare meals.
  • Run errands, fill prescriptions, and do chores around the house.
  • Provide support, encouragement, and entertainment.
  • Keep family and friends informed of your needs and desires.
  • Assist with daily activities within the home.



Life after Lung Transplant

The transplant team will continue to be a resource for you and will remain in contact with you, even after you leave the hospital. Lung transplantation can help patients live longer and have a better quality of life. However, you will need to take an active role to help make your transplant a success.

Maintaining Your Optimum Weight

After your surgery, it’s important to maintain an optimum weight. This allows your new lungs to work at their best function. Excess weight will increase the work your lungs should do to pump your blood to all or any of the cells of your body. Excess weight will also cause stress on your joints and lead to pain; it also stresses your bones, making them more prone to breaking. The best way to control your weight is with the correct diet and exercise. After transplantation, diet becomes a very important part of your life. The drugs you take to prevent rejection have several side effects that make a “heart-healthy” diet a necessity. The doctor will work with you to develop a healthy and controlled consumption attempt to assist you to maintain your optimum weight.

Caffeine, Alcohol, and Tobacco

These commonly-used substances can be eliminated or severely restricted in your new healthy manner.

Caffeine is a stimulant of the central nervous system and can overstimulate your heart. Some are extremely sensitive to caffeine intake than others. It can cause insomnia, heartbeat irregularities, and diarrhoea. Even a moderate amount of caffeine can promote headaches, trembling and nervousness. Your doctor will advise you on the need to limit your use of caffeinated products like coffee, tea, chocolate, and sodas.

Alcohol consumption ought to be eliminated or severely restricted after your transplant. Alcoholic beverages are high in calories, low in nutrients and can increase the level of triglycerides in your blood. Even more important is the fact that alcohol can impair your liver’s function. Several transplant medications are broken down in the liver. So, for your medications to work properly and safeguard your new lung from rejection, it's essential that your liver be healthy and properly functioning.

Smoking tobacco is a high-risk activity. We strongly recommend that you do not smoke. Smoking lessens the ability of your red blood cells to carry oxygen; less oxygen reaches your tissues, decreasing your ability to heal. Smoking constricts your blood vessels, especially those in your legs, arms, and heart. All of these problems are accentuated in individuals taking immunosuppressive medications.



Lung Transplant FAQs: All your Concerns Addressed

Q.  How long will a lung transplant last?

  1. Although some individuals have lived ten years or additional after a lung transplant, solely regarding half the people that endure the procedure are still alive once 5 years.

Q.  Who is eligible for a lung transplant?

  1. In general, you need to be physiologically sixty years aged or less for bilateral lung transplantation and sixty-five years aged or less for single lung transplantation. This means that your fitness should meet the everyday condition of somebody over sixty years or younger, or somebody over sixty-five years or younger.

Q.  Can you live with one lung?

  1. Living with one lung doesn't usually affect everyday tasks or life expectancy, though a person with one lung wouldn't be able to exercise as strenuously as a healthy person with two lungs.

Q.  What are the signs of lung failure?

  1. When symptoms do develop, they may include:
  • Difficulty respiration or shortness of breath, particularly once active.
  • Coughing up mucus.
  • Wheezing.
  • Rapid breathing.
  • Fatigue.
  • Anxiety.
  • Confusion.

Q.  Do Lung Transplants work?

  1. A lung transplant is an operation to remove and replace a diseased lung with a healthy human lung from a donor. The procedure usually takes between 4 and 12 hours to complete, depending on the complexity of the operation. In case of a major operation, the patient might take at least 3 months to recover. However, eventual complications after lung transplant can happen if adequate care is not taken. The immune system of the patient may reject the newly received organ from a donor, hence immunosuppressant medications are prescribed. In the case of lung failure, a lung transplant can definitely help to improve the quality of life and the longevity of life for patients suffering from grave lung conditions.

Q.  What are the different types of lung transplants?

  1. There are 3 main types:
    Single Lung Transplant: A single damaged lung is removed and replaced with a healthy lung. This is often used to treat pulmonary fibrosis.
    Double Lung Transplant: Both the lungs are surgically removed and replaced with 2 healthy lungs of donor. This is the prime treatment option for people with cystic fibrosis or COPD.
    Heart-Lung Transplant: It is the removal of the heart and both the lungs. This is often recommended for people with severe pulmonary hypertension.

Q.  Why is a lung transplant performed?

  1. Lung transplants are only recommended for people who have tried other treatments or medications, but their conditions haven't sufficiently improved.
    Damaged or unhealthy lungs can't intake or utilise the oxygen which the body needs to survive. A variety of medical conditions and diseases can damage the lungs and hinder the ability to function effectively. Some of the more common causes include:
    • Chronic obstructive pulmonary disease (COPD), including emphysema
    • Scarring of the lungs (pulmonary fibrosis)
    • High blood pressure in the lungs (pulmonary hypertension)
    • Cystic fibrosis

Q.  How long does it take to recover after a lung transplant?

  1. The recovery period varies from person to person. Some leave the hospital within a few days, while some take a few weeks. However, it's not uncommon for a patient to be in the hospital for two weeks or longer. To completely recover from the condition it takes at least 3 to 6 months. One must avoid pushing, pulling or lifting anything heavy. For the long term success of the transplant, a few weeks after the surgery are filled with activities like:
    • Rehabilitation exercises
    • Regular physical therapy
    • Informative sessions to learn the lifelong medication plan
    • Regular tests of lung function, blood tests, chest X-ray, and procedures like bronchoscopy

Q.  Can the lungs be detoxified?

  1. Lungs are self-cleaning organs and it's completely possible to clean and detox the lungs. Here are a few tips to follow for optimal lung health:
    • Quit Smoking
    • Maintain a proper diet
    • Exercise regularly
    • Breath in the fresh air, be in a toxin-free environment.
    • Steam therapy or steam inhalation
    • COPD patients should try pursed breathing.
    • Drain mucus from the lungs. There are a few postural drainage techniques to do so.

Q.  What is the success rate of lung transplants in India?

  1. Lung transplant is the solution for the termination of end-stage lung diseases. If you compare the preoperative and postoperative conditions of the lung transplanted patients in the developing and developed countries, they're different. Modern techniques that are used for lung transplant work on both the determinants and the failed organ. Physicians (Surgeon), along with the organ, removes the infection and pacify the causes of the ailment. You can say that lung transplant surgery has gained little success due to the new techniques.

Q.  How much does a lung transplant cost?

  1. The shortage of donors for lung transplant procedure makes it a little expensive. Lung transplant surgery cost around 10 to 25 lakh. The ICU and medications will cost you an equal amount.

Q.  Does diabetes or high blood pressure affect lung transplant?

  1. Unfortunately, yes, your high blood pressure or diabetes level may create insurmountable barriers in the lung transplant procedure. On the contrary, diabetes or elevated blood pressure can also augment the number of issues for your lungs. Before investing in lung transplant surgery, adopt a medication course to control your diabetes or hypertension.



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