All You Need To Know About Lung Transplant - Before, During, & After

The global burden of severe lung diseases is on the rise, but there is a positive shift happening. Lung transplant, which has been successfully performed for 30 years, has now been firmly established as a standard of care for selected patients with end-stage lung disease. Thanks to advancements in donor management, lung preservation, surgical techniques, immunosuppressive treatments, and dedicated post-operative care. Lung transplantation surgery is now routinely carried out worldwide, benefiting an increasing number of patients with broader eligibility criteria.

Furthermore, ongoing research into the underlying causes of acute and chronic lung graft rejection, along with the development of personalized diagnostic and therapeutic approaches for both donors and recipients, instills confidence in the prospect of continued improvements in both short-term and long-term outcomes in the coming years.

Therefore, it's crucial to grasp the thorough and appropriate understanding of the complexities involved in this procedure if you or your known one is opting this end-stage lung disease treatment option.

Pre-Evaluation:

The initial assessment for a lung transplant includes the following steps:

Psychological and Social Evaluation: This involves an evaluation of your emotional well-being, financial considerations, and the support system provided by family and loved ones. These factors can significantly impact the transplant's success.

Blood Tests: Blood tests are essential to identify a suitable donor match, increasing the likelihood of successful organ acceptance and reducing the risk of rejection.

Diagnostic Tests: Various diagnostic tests are conducted to assess your lung and overall health. These tests may include X-rays, ultrasound, CT scans, pulmonary function assessments, lung biopsy, and dental examinations. For women, it may also involve a Pap test, gynecological evaluation, and mammogram.

Smoking Cessation: Lung transplant candidates who smoke must quit and remain nicotine-free for several months before being eligible for the transplant list.

Other Preparations: Immunizations may be administered to reduce the risk of infections that could affect the transplanted lung.

Once accepted as a lung transplant candidate, you will be added to a waiting list, with waiting times varying based on factors such as organ type, age, blood type, and the underlying reason for transplantation. When a suitable organ becomes available from a deceased donor, you will receive notification to prepare for the transplant.

Preparation on the day of transplant:

1. You will be required to provide consent by signing a form that grants permission for the surgery. It's essential to review the form carefully and seek clarification if you have any questions.

2. Typically, you should abstain from eating or drinking for a minimum of 8 hours prior to the scheduled surgery, often beginning after midnight.

A hospital stay is necessary for a lung transplant procedure, and the specific approach can vary based on your condition and your healthcare provider's preferences. In most cases, the procedure follows these steps:

1. You will change into a hospital gown and remove any jewelry or personal items.

2. A plastic bracelet with your name and identification number will be placed on your wrist, and an additional one may be provided for allergies.

3. An intravenous (IV) line will be inserted into your arm or hand.

4. Thin, flexible tubes (catheters) will be placed in your neck, wrist, beneath the collarbone (subclavian), or the groin to monitor your heart, blood pressure, and collect blood samples.

5. You will lie on an operating table, with the position depending on whether it's a single lung transplant (lying on your side) or a bilateral sequential lung transplant (lying on your back with arms raised above your head).

6. You will receive general anesthesia to ensure you are pain-free and asleep during the procedure.

7. A breathing tube will be inserted into your throat, connected to a ventilator. Your vital signs, including heart rate, blood pressure, and breathing, will be closely monitored.

8. A catheter will be placed in your bladder to manage urine during the surgery.

9. If necessary, any hair at the surgical site may be trimmed, and the skin will be cleaned with an antiseptic solution.

10. The surgeon will make an incision in your chest, with the location determined by the specific transplant type. For a single lung transplant, the incision will be made on the side where the lung is being replaced, while for a bilateral sequential transplant, the incision will be horizontal below the breasts.

11. Depending on your lung condition and the transplant type, you might be connected to a cardiopulmonary bypass machine (heart-lung machine) to maintain blood and oxygen circulation during the procedure.

12. The diseased lung(s) will be removed and replaced with the donor lung(s). The new lung's blood vessels and airways will be connected, and for a bilateral sequential transplant, the lungs will be attached one at a time.

13. The incision will be closed using stitches or surgical staples.

14. A bandage or dressing will be applied to the incision site.

15. Chest tubes will be inserted to remove air, fluid, and blood from the chest cavity and allow the new lung(s) to fully expand.

16. In some cases, an epidural catheter may be placed to administer pain medication into your back, either in the operating room or in the recovery area.

After the Lung Transplant procedure, you may expect following:

ICU Care: Following the surgery, you will undergo an initial recovery period within the hospital's intensive care unit (ICU). During this phase, a mechanical ventilator will assist your breathing for a few days, while tubes in your chest will drain fluids from around your lungs and heart. Pain management and prevention of lung rejection will be facilitated through a vein-delivered regimen of potent medications immediately after the surgery. 

In-Hospital Care: As your condition progresses positively, you will no longer require the mechanical ventilator, and you will be relocated from the ICU. The duration of your hospital stay during the recovery period typically ranges from one to three weeks, although this stay may vary according to circumstances.

Post-Discharge Monitoring: Upon discharge from the hospital, you will need to undergo approximately three months of frequent monitoring by the lung transplant team. This is crucial for the early detection, prevention, and treatment of potential complications, as well as for the assessment of your lung function. During this initial monitoring phase, it is generally advisable to remain in proximity to the transplant center. 

Follow-Up Plan: Subsequently, follow-up visits tend to become less frequent, allowing for travel back and forth as needed. These follow-up appointments may encompass a range of evaluations, including laboratory tests, chest X-rays, electrocardiograms (ECGs), lung function assessments, and periodic lung biopsies. A lung biopsy, conducted during a bronchoscopy, involves the removal of small lung tissue samples to examine for signs of rejection and infection. 

Complication Monitoring: Your transplant team will closely monitor your progress and assist you in managing any side effects associated with immunosuppressive medications. Vigilance for infections will also be a priority, with potential prescription of antibiotics, antiviral drugs, or antifungal medications to mitigate infection risks. Furthermore, your transplant team will offer guidance on infection prevention practices to adopt at home. Additionally, continuous surveillance for signs or symptoms of rejection, such as shortness of breath, fever, coughing, and chest congestion, will be an integral part of your post-transplant care.

India is actively striving to improve recipient selection processes to achieve more positive outcomes under affordable cost of lung transplant. At the same time, there are ongoing developments in strategies aimed at expanding the donor pool. Emphasizing the importance of strong patient cooperation, better follow-up care is advocated, with more focus on regular communication with the transplant center, all contributing to an overall enhancement of these aspects.

Presently, India witnesses approximately 100-120 lung transplant procedures performed each year, distributed among the 4-5 prominent centers that offer this service. Therefore, people from around the world currently have excellent opportunities to avail services from best doctors for lung transplant and best hospitals for lung transplant in India.

Make sure to find a proficient transplant surgeon who can work closely with you to plan your surgery and facilitate a speedy recovery. Rely on Medflick as your dependable source for precise, current, and trustworthy information regarding lung transplant or lung replacement procedures. Your health and overall well-being deserve nothing less than well-informed and responsible guidance.