Lung transplant is surgery to replace one or both diseased lungs with healthy lungs from a human donor.

The new lung or lungs are usually donated by someone who has been declared brain-dead but remains on life-support. The donor tissue must be matched as closely as possible to your tissue type to reduce the odds that your body will reject the transplanted lung.

Lungs can also be given by living donors. Two or more people are needed. Each donates a section (lobe) of their lung to form an entire lung for the person receiving it.

Why the Procedure is Performed

A lung transplant is usually a last-resort treatment for lung failure. Lung transplants may be recommended for patients with any severe lung disease. Some examples of diseases that may require a lung transplant are:

• Cystic fibrosis
• Emphysema
• Idiopathic pulmonary fibrosis
• Pulmonary hypertension
• Sarcoidosis
• Damage to the arteries of the lung because of a defect present at birth (congenital defect)

Lung transplant is not recommended for:

• Patients who are too sick to go through the procedure
• Patients whose lung disease will likely affect the new lung
• Patients who have severe disease of other organs

Understanding the Procedure

During lung transplant surgery, you are unconscious and pain-free (under general anesthesia). A surgical cut is made in the chest.

• For single lung transplants, the cut is made on the side of your chest that will be receiving the lung. The operation takes 4 - 8 hours.
• For double lung transplants, the cut is made below the breast. Surgery generally takes 6 - 12 hours. Tubes are used to reroute blood to a heart-lung bypass machine to provide oxygen and move blood through the body during the surgery.

After the cut is made, the major steps during lung transplant surgery include:

• One or both of your lungs are removed. For those receiving a double lung transplant, most or all of the steps from the first transplant are completed before the second transplant is done.
• The main blood vessels and airway of the new lung are sewn to your main blood vessel and airway. The donor lung or lungs are stitched (sutured) into place. Chest tubes are inserted to drain air, fluid, and blood out of the chest for several days to allow the lungs to fully re-expand.

Sometimes heart and lung transplants are done at the same time (heart-lung transplant) if the heart is also diseased.
 

Risks

Risks for any anesthesia are:

• Breathing problems
• Reactions to the medications

Risks for any surgery are:

• Bleeding
• Infection

Other risks of transplant include:

• Blood clots (deep venous thrombosis)
• Increased risk for infections due to anti-rejection (immunosuppression) medications
• Damage to your kidneys, liver, or other body organs from immunosuppression medications
   

Outlook (Prognosis)

A lung transplant is a major procedure performed for patients with life-threatening lung disease or damage. Around four out of five people are still alive 1 year after the transplant. Around half of transplant recipients are alive at 5 years. Outcomes are similar for single and double lung transplants.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ as an invader (much like an infection) and may attack it.

To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids). These drugs suppress the body's immune response and reduce the chance of rejection. As a result, however, these drugs also reduce the body's natural ability to fight off infections.