Overview
A lung transplant is an operation to remove and replace a diseased lung with a healthy human lung from a donor.
A donor is usually a person who's died, but in rare cases a section of lung can be taken from a living donor.
When a lung transplant is needed
A lung transplant will often be recommended if:
- a person has advanced lung disease that's not responding to other methods of treatment
- a person's life expectancy is thought to be less than 2 to 3 years without a transplant
Conditions that can be treated with a lung transplant include:
Types of transplant
There are 3 main types of lung transplant:
- a single lung transplant – where a single damaged lung is removed from the recipient and replaced with a lung from the donor; this is often used to treat pulmonary fibrosis, but it's not suitable for people with cystic fibrosis because infection will spread from the remaining lung to the donated lung
- a double lung transplant – where both lungs are removed and replaced with 2 donated lungs; this is usually the main treatment option for people with cystic fibrosis or COPD
- a heart-lung transplant – where the heart and both lungs are removed and replaced with a donated heart and lungs; this is often recommended for people with severe pulmonary hypertension
The demand for lung transplants is far greater than the available supply of donated lungs.
This means a transplant will only be carried out if it's thought there's a relatively good chance of it being successful.
For example, a lung transplant would not be recommended for someone with lung cancer because the cancer could come back in the donated lungs.
You also will not be considered for a lung transplant if you smoke.
Living donors
It's possible for a person to receive a lung transplant from living donors (2 living donors are usually required for 1 recipient).
But lung transplants from living donors are currently rare in the UK.
During this type of lung transplant, the lower lobe of the right lung is removed from 1 donor and the lower lobe of the left lung is removed from the other donor.
Both lungs are removed from the recipient and replaced with the lung implants from the donors in a single operation.
Most people who receive lung transplants from living donors have cystic fibrosis and are close relatives of the donors.
The recipient and donors need to be compatible in size and have matching blood groups.
Preparation
Before being placed on the transplant list you'll need to have some tests to make sure your other major organs, such as your heart, kidneys and liver, will function properly after the transplant.
You may also need to make lifestyle changes, such as giving up smoking and losing weight if you're overweight, so you're as healthy as possible when it's time for the transplant to take place.
The lung transplant procedure
A lung transplant usually takes between 6 and 8 hours to complete, depending on the complexity of the operation.
A cut is made in your chest and the damaged lungs are removed.
Depending on your individual circumstances, you may be connected to a heart and lung bypass machine to keep your blood circulating during the operation.
The donated lungs will then be connected to the relevant airways and blood vessels, and the chest will be closed.
A lung transplant is a major operation that may take several months to recover from.
It could be quite a while before you're able to return to work, so you'll need to make necessary arrangements with your employer.
Risks
A lung transplant is a complex type of surgery that carries a high risk of complications.
A common complication is the immune system rejecting the donated lungs.
Because of this, a medicine known as an immunosuppressive is given to dampen the effects of the immune system, reducing the risk of rejection.
But taking immunosuppressives carries its own risks as they increase the chances of infection.
Outlook
The outlook for people who have had a lung transplant has improved in recent years and it's expected to continue improving.
In 2022, the NHS Blood and Transplant service reported that on average:
- 83 people out of 100 live for 1 year after a lung transplant
- 55 people our of 100 live for 5 years after a lung transplant
Organ donation
Find out more from Welsh Government: guide to organ donation
Preparation
If a lung transplant is thought to be an option for you, you'll be referred for a transplant assessment.
Transplant assessment
Tests will be carried out to make sure your other major organs, such as your heart, kidneys and liver, will function properly after the transplant.
These may include blood tests and any of the following investigations:
After the assessment is complete, a decision will be made as to whether a lung transplant is suitable for you and whether it's the best option.
It may be decided that:
- you should go on the active waiting list – which means you could be called for a transplant at any time
- a transplant is suitable for you, but your condition is not severe enough – you'll be reviewed regularly and if your condition worsens, you'll be put on the active waiting list
- you need more investigations or treatment before a decision can be made
- a transplant is not suitable for you – the assessment team will explain why and offer alternatives, such as medicine or other surgery
- you need a second opinion from a different transplant centre
Why a lung transplant might be unsuitable
The supply of donor lungs is limited, which means there are more people who'd benefit from a lung transplant than there are donor lungs.
This means people who are unlikely to have a successful transplant are not usually considered suitable for transplant.
You may also be considered unsuitable if:
- you have not given up smoking
- your other organs, such as your liver, heart or kidneys, do not function well and may fail after the stresses of the transplant operation
- your lung disease is too advanced, so it's thought you'd be too weak to survive surgery
- you have a recent history of cancer – there's a chance that the cancer could spread into the donated lungs; exceptions can be made for some types of skin cancer as these are unlikely to spread
- you have another condition or infection that would make the transplant too dangerous
- you're significantly underweight with a body mass index (BMI) of less than 17, or very overweight (obese) with a BMI of 30 or above
- you have a serious mental health condition that has been difficult to treat
- you have an alcohol or drug addiction and have been using in the past 6 months
Age also plays a part because of the effect it has on likely survival rates.
There are no set rules and exceptions can sometimes be made.
The waiting list
The length of time you'll have to wait will depend on your blood group, donor availability and how many other people are on the list and how urgent their cases are.
While you wait, you'll be cared for by the doctor who referred you to the transplant centre.
They'll keep the transplant team updated with changes to your condition.
Another assessment is sometimes necessary to make sure you're still suitable for a transplant.
Your transplant team will often be given short notice of donor organs, so will have to move swiftly.
When a suitable donor is found, you'll usually need to be in hospital ready for your transplant within 6 to 8 hours.
If you live a long way from a transplant centre, you'll be flown to the centre or taken by ambulance.
Getting the call
When a suitable donor lung is found, the transplant centre will contact you and ask you to go to the centre.
When you hear from the transplant centre:
- do not eat or drink anything
- take all current medicines with you
- take a bag of clothes and essentials for your stay in hospital
At the transplant centre, you'll be quickly reassessed to make sure no new medical conditions have developed.
At the same time, a second medical team will examine the donor lungs.
The lung transplant must be carried out as quickly as possible to ensure it has the best possible chance of being successful.
How is it performed?
A lung transplant usually takes between 6 and 8 hours, depending on the complexity of the operation.
After you have had a general anaesthetic, a breathing tube will be placed down your throat so your lungs can be ventilated.
The surgeon will make a cut in your chest so your chest can be opened and preparations made to remove the diseased lung or lungs.
If assistance with your circulation is needed, a cardiopulmonary bypass machine may be used to keep your blood circulating during the operation.
The old lung will be removed and the new lung sewn into place.
When the transplant team is confident the new lung is working efficiently, your chest will be closed and you'll be taken off the bypass machine.
Tubes will be left in your chest for several days to drain any build-up of blood and fluid.
You'll be taken to the intensive care unit, where more tubes will be attached to supply your body with medicine and fluids and to drain pee from your bladder.
Risks
A lung transplant is a complex operation and the risk of complications is high.
Some complications are related to the operation itself. Others are a result of the immunosuppressive medicine, which is needed to prevent your body rejecting the new lungs.
Reimplantation response
Reimplantation response is a common complication affecting almost all people with a lung transplant.
The effects of surgery and the interruption to the blood supply cause the lungs to fill with fluid.
Symptoms include:
The symptoms are usually at their worst 5 days after the transplant.
These problems will gradually improve, and most people are free of symptoms by 10 days after their transplant.
Rejection
Rejection is a normal reaction of the body. When a new organ is transplanted, your body's immune system treats it as a threat and produces antibodies against it, which can stop it working properly.
Most people experience rejection, usually during the first 3 to 6 months after the transplant.
Shortness of breath, extreme tiredness (fatigue) and a dry cough are all symptoms of rejection, although mild cases may not always cause symptoms.
Acute rejection usually responds well to treatment with steroid medicine.
Bronchiolitis obliterans syndrome
Bronchiolitis obliterans syndrome (BOS) is another form of rejection that typically occurs in the first year after the transplant, but could occur up to a decade later.
In BOS, the immune system causes the airways inside the lungs to become inflamed, which blocks the flow of oxygen through the lungs.
Symptoms include:
- shortness of breath
- a dry cough
- wheezing
BOS may be treated with additional immunosuppressant medicine.
Post-transplantation lymphoproliferative disorder
After having a lung transplant, your risk of developing a lymphoma (usually a non-Hodgkin lymphoma) is increased. Lymphoma is a type of cancer that affects white blood cells.
This is known as post-transplantation lymphoproliferative disorder (PTLD).
PTLD occurs when a viral infection (usually the Epstein-Barr virus) develops as a result of the immunosuppressants that are used to stop your body rejecting the new organ.
It can usually be treated by reducing or withdrawing immunosuppressant therapy.
Lymphoma Action has more information about lymphoma.
Infection
The risk of infection for people who have received a lung transplant is higher than average for a number of reasons.
Common infections after a transplant include:
Long-term use of immunosuppressants
Taking immunosuppressant medicine is necessary following any type of transplant, although they do increase your risk of developing other health conditions including:
- kidney disease
- diabetes
- high blood pressure
- osteoporosis
- some cancers
Cancers
People who have received a lung transplant have an increased risk of developing cancer at a later date.
This would usually be one of the following:
Because of this increased risk, regular check-ups for these sorts of cancers may be recommended.
Recovery
After lung transplant surgery, you'll remain in the intensive care unit for around 1 to 5 days.
You will be given pain relief, which may include an epidural (a type of local anaesthetic) for pain relief and will be connected to a ventilator to help your breathing.
You'll be carefully monitored so the transplant team can check your body is accepting the new organ.
Monitoring will include having regular lung X-rays and lung biopsies, where tissue samples are taken for closer examination.
The transplant team will be able to see whether your body is rejecting the lung from the biopsy results.
If it is, you'll be given additional treatment to reverse the process.
When your condition is stable, you'll be moved to a high dependency ward, where you'll stay for 1 or 2 weeks.
Follow-up appointments
You'll probably be discharged from hospital 2 to 3 weeks after surgery and asked to stay near the transplant centre for a month so you can have regular check-ups.
At first, you will usually need to attend appointments twice a week. As you recover, you will need fewer check-ups.
After that, for the rest of your life you'll need to be seen at the transplant centre every 3 to 6 months.
The recovery process
It usually takes at least 3 to 6 months to fully recover from transplant surgery.
For the first 6 weeks after surgery, avoid pushing, pulling or lifting anything heavy.
You'll be encouraged to take part in a rehabilitation programme involving exercises to build up your strength.
You should be able to drive again 6 to 8 weeks after your transplant, once your chest wound has healed and you feel well enough.
Depending on the type of job you do, you'll be able to return to work around 4 to 5 months after surgery.
Immunosuppressant therapy
You'll need to take immunosuppressant medicines, which weaken your immune system so your body does not try to reject the new organ.
You'll need to take immunosuppressant therapy for the rest of your life.
Most transplant centres use the following combination of immunosuppressants:
- tacrolimus
- mycophenolate mofetil
- steroids
The downside of taking immunosuppressants is that they can cause a wide range of side effects, including:
- mood changes, such as depression or anxiety
- insomnia
- diarrhoea
- swollen gums
- bruising or bleeding more easily
- convulsions
- dizziness
- headache
- acne
- extra hair growth (hirsutism)
- weight gain
Your doctor will try to find an immunosuppressant dose that's high enough to dampen the immune system, but low enough that you experience few side effects. This may take several months to achieve.
Even if your side effects become troublesome, you should never suddenly stop taking your medicine as your lungs could be rejected.
Long-term use of immunosuppressants also increases your risk of developing other health conditions, such as kidney disease.
Find out more about the risks associated with long-term immunosuppressants use.
Preventing infection
Having a weakened immune system is known as being immunocompromised.
If you're immunocompromised, you'll need to take extra precautions against infection.
You should:
- practise good personal hygiene – take daily baths or showers and make sure that clothes, towels and bed linen are washed regularly
- avoid contact with people with infections that could seriously affect you, such as chickenpox or flu
- wash your hands regularly with soap and hot water, particularly after going to the toilet and before preparing food and eating meals
- take extra care not to cut or graze your skin – if you do, clean the area thoroughly with warm water, dry it and cover it with a sterile dressing
- keep up to date with regular immunisations – your transplant centre will supply you with all the relevant details
You should also look out for any initial signs that may indicate you have an infection. A minor infection could quickly turn into a major one.
Tell a GP or your transplant centre immediately if you have symptoms of an infection, such as:
- a high temperature
- a headache
- aching muscles
The information on this page has been adapted by NHS Wales from original content supplied by 
NHS website nhs.uk
Last Updated:
18/10/2023 11:10:45