A Guide to Lung Transplantation

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Benefits and Risks of Lung Transplantation

Benefits

Quality of life can be moderately to substantially improved by lung transplantation, and life may be extended beyond your life expectancy prior to transplantation. It is impossible to predict how long you may survive after transplantation. The most critical period for survival, of a patient and of the donor lung(s), is the first year after transplantation; this is the period when surgical complications, rejection, and infection (see "Risks") 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 5 or even more years ago.

Each lung transplant center has survival statistics for its transplantation 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. This process of foreign-tissue rejection 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 keep the rejection process "turned off." 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 begin despite your compliance with prescribed medication.

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, shortness of breath, decreased urine output, and pain over the transplanted lung. Your transplant team will instruct you regarding who to call to immediately report any such symptoms. Regular check-ups are also necessary to detect rejection that can occasionally occur without noticeable symptoms.

Immunosuppressive medications you will be taking may include cyclosporine, tacrolimus (alone but never with cyclosporine), azathioprine, mycophenolate, and prednisone. Dosage of some of these may be increased by your physicians if a rejection process begins.

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 infection, and infections are more likely to 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. Symptoms of infection include fever, sore throat, cough, shortness of breath, redness or draining pus at the site of your surgical incision, pain during urination, vomiting, or diarrhea.

Other Complications

Pain, loss of appetite, and weight loss are other possible complications. Your physicians and the transplant team will, with your cooperation, help you manage them.

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