A Guide to Lung Transplantation

Benefits

Quality of life may be substantially improved by lung transplantation, and life may be extended beyond your life expectancy without transplantation. It is impossible to predict how long you may survive after transplantation. The most critical period for survival is the first year after transplantation; this is the period when surgical complications, rejection, and infection (see Risks below) are the greatest threat to survival. Patients who survive the first year are more likely to survive 3 years or longer after transplantation. There are patients alive today who had lung transplantation 10 or even 15 years ago.

Each lung transplant center has survival statistics for its transplantation programs. For American transplant programs, these statistics are available from the United Network for Organ Sharing (UNOS). The UNOS telephone number and World Wide Web address are given at the end of this brochure. You should discuss this information with your physician and the transplant team.

Risks

Rejection and infection are the two major complications of lung transplantation. You must cooperate completely with your physicians to try to keep these complications from developing or to keep them under control if they do occur.

Rejection

Because your transplanted lung(s) is "foreign" to your body, your body's immune system will try to destroy it—just as it tries to destroy "foreign" bacteria and viruses when they invade. Your immune system helps protect you from illness, but the process has to be "turned off" to keep your transplanted lung(s) from being destroyed.

Immunosuppressive (antirejection) medications prescribed by your doctors will help slow down and control the rejection process. Other medications may be necessary to control and treat rejection if your immune system breaks through the immunosuppressive blockade. Following your doctors' orders and taking all medications as prescribed help to prevent or control rejection. However, sometimes rejection can occur even despite your best efforts.

The most likely time for rejection to begin is during the first 3 months after transplantation surgery. Symptoms of rejection include fever, chills, flu-like aches, and shortness of breath. Your transplant team will instruct you regarding who to call to immediately report any such symptoms. Regular check-ups, x-rays, and breathing tests are also necessary to detect rejection that can occasionally occur without noticeable symptoms. Some programs take tiny biopsies of the lung through a device called a bronchoscope to screen for this "silent" rejection.

Immunosuppressive medications you will be taking in combination may include prednisone, cyclosporine or tacrolimus, azathioprine or mycophenolate, or other medications. The dosages of these drugs may be adjusted frequently by your physicians in response to drug levels, rejection, or side effects.

Infection

Because you will be taking immunosuppressive medications, your immune system will be less able to fight off invading bacteria and viruses. You will be much more susceptible to infections, which can become severe.

You have an important role in the prevention of infection—by following instructions to avoid exposure to infection, and immediately reporting any symptoms of infection.

Other Complications

Many other complications are possible, including medication side effects, long-term problems with function of the transplanted lungs, and certain types of cancer. Your physicians and the transplant team will discuss these potential complications with you before transplantation and help you manage them after transplantation.