Lung transplants
A lung transplant may be the only option for patients with end-stage lung disease who have not responded to conventional treatment, and whose survival is predicted at less than two years.
Learn more from our transplant team
Krista Porter RN, Transplant Nurse Coordinator
Heidi Bougher RN, Transplant Coordinator
Morgan Britt RN, Transplant Coordinator
A lung transplant is a major operation, but it can greatly improve your health and quality of life. UCHealth specialists have helped pioneer the procedure since 1991. Today we are on the leading edge of full-service single and double lung transplants, using the latest scientific and technological advancements that lead to better outcomes. For example:
- Our program uses a multidisciplinary approach, which means you can see your team of experts in one visit at one location.
- We’re continually conducting research to minimize rejection and make better use of donor lungs.
- We perform ex-vivo to help increase the donor pool.
- Since 1991, we have performed more than 600 transplants.
Lung transplant evaluation
After we receive your referral, we will perform a series of tests to evaluate your current health and if you are a candidate for lung transplantation.
After these tests are performed, members of the transplant medical team will conduct a thorough evaluation in our clinic. Our evaluation process takes about three days. During this time, we incorporate different screenings and tests, as well as appointments with our team members in order to review your health status.
Multidisciplinary approach to determining lung transplant candidacy
A multidisciplinary selection committee
After you complete all testing and requirements for your evaluation, your case will be presented to the Lung Selection Committee. This committee is made up of our multidisciplinary team that includes transplant doctors, transplant surgeons, nurse coordinators, social workers, transplant pharmacists, financial coordinators, dietitians and others who are involved in lung transplant. They determine whether lung transplant surgery is safe for you. They will also discuss a plan of care for you after transplant. It will take approximately one to two weeks to review your case. Your transplant coordinator will inform you of the committee’s decision and plan.
If you are accepted for a lung transplant, your name and other key medical information are entered into the United Network for Organ Sharing (UNOS) database and put on the waiting list. This national, computerized listing is maintained to ensure fair and equitable distribution of donated organs.
Prioritizing transplant candidates
We follow the UNOS system for prioritizing transplant candidates. For this system to work, it relies on organ procurement organizations, called OPOs. OPOs match and distribute donated organs, 24 hours a day, 365 days a year. The OPO in our region is Donor Alliance (DA). DA is responsible for the coordination, retrieval and distribution of organs in Colorado and Wyoming.
Getting ready for a lung transplant
Staying ready means staying healthy
During the waiting period, you will begin a pulmonary rehabilitation program. A rehabilitation specialist and pulmonologist will design an exercise program to improve your muscle strength and endurance. This will help you to have a more successful recovery after your transplant.
Your pulmonologist will keep the transplant surgeon and coordinator informed about changes in your condition. If you live far away from the UCHealth Anschutz medical campus, your care may be managed by your primary care doctor. However, it’s important that you see your transplant center pulmonologist on a monthly basis. You will also be given guidelines about diet and exercise.
Patients on the waiting list may be randomly screened for drugs or alcohol at any time, using a blood or urine sample. Anyone who tests positive for alcohol or illegal drugs will be removed from the waiting list. Additionally, we screen for cigarette smoking use. Our program requires you to have quit smoking for at least six months prior to accepting you for evaluation for lung transplantation.
Lung transplant surgery
Lung transplant surgery is performed under general anesthesia. Single lung transplants and double lung transplants involve different processes.
Single lung transplant
An incision is made on the side of your chest that will receive the transplant. During the transplant, you will breathe with only one lung. If you cannot breathe well enough, we will place you on a cardiopulmonary bypass machine that takes over the work of your lung by putting oxygen into your blood and removing carbon dioxide from your blood. After the new lung is in place, chest tubes will be placed to remove any extra fluid from the area and your incision is closed.
A single lung transplant lasts approximately four hours.
Bilateral (double) lung transplant
An incision is made across your entire chest at the base of your breasts. Each lung is replaced separately. The most diseased lung is removed first and replaced with the new organ. During the first transplant, you will breathe with your other lung. If you cannot breathe well enough, you may be placed on a cardiopulmonary bypass machine that takes over the work of your lung by putting oxygen into your blood and removing carbon dioxide from your blood.
After first new lung is in place, the same process is used to replace your other diseased lung. Cardiopulmonary bypass may be used during the second phase of the transplant to reduce stress on your heart and the new lung. Chest tubes will be placed to remove any extra fluid from the area and your incision is closed.
A bilateral lung transplant lasts approximately six to eight hours.
Complications and risks following lung transplant surgery
Complications
- Bleeding
- Lung non-function
- Infection
- Pain
- Organ failure
- Death
Risks
- Rejection
- Blood clots
- Mental confusion
- Seizures
Infection
These anti-rejection drugs suppress your immune system, which makes you more susceptible to infections, particularly in your lungs. To help, you should:
- Regularly wash your hands and brush your teeth and gums.
- Protect your skin from scratches and sores.
- Avoid sick people and crowds.
- Get all appropriate vaccinations.
Rejection
Even with the best possible match between you and the donor, your immune system will treat your new lung as a foreign body and will try to attack and reject it. This risk is highest immediately after transplant, but will reduce over time. We will put you on immunosuppressant medications to suppress your immune system, which may have side effects, and you will most likely take them for life.
Post-surgical care after a lung transplant
Specialized care after your surgery
After your surgery, we will take you to a private room in the intensive care unit (ICU) for recovery. You’ll have a breathing tube that’s hooked up to a respirator to help you breathe, and you’ll remain on the respirator for 24 to 48 hours. You’ll be given medication to keep you sleepy and unable to move. Depending on your condition, your medication will be decreased, and you’ll gradually be able to breathe on your own without the respirator.
Once you can breathe on your own, the breathing tube will be removed. A respiratory therapist will help you do breathing exercises and coughing to get you stronger and prevent pneumonia. Your stay in the ICU will usually last two to three days, but may be longer depending on your condition.
From the ICU, you’ll go to a room in a specialized transplant unit where you’ll begin a closely monitored recovery process. You’ll work with our pulmonary rehabilitation specialist and physical therapist to improve your strength and conditioning. You and your family will participate in various educational sessions with our multidisciplinary team about some of the following topics to prepare you for discharge from the hospital:
- Medication.
- Diet.
- Exercise program.
- Follow-up care including clinic visit schedules, home care needs and procedures.
Your stay will last three to 10 days depending on your condition.
You’ll need to be on immunosuppressant medications to suppress your immune system from rejecting your donor lung(s). It’s likely that you will take these anti-rejection drugs for life, which can have side effects.
References
American Lung Association. Lung Transplant (https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/lung-transplant)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Overview of Clinical Lung Transplantation (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869283/)