Lung Transplant

Medica’s Lung Transplant Programme

Lung Transplant is a surgical procedure that is performed to replace severely damaged or diseased lung/lungs with a healthy one, usually from a deceased donor. It is a treatment plan recommended only after all other all other avenues have failed to yield much result. Though a complex surgery, lung transplant is often a life-saving procedure and can vastly improve quality of life. In some patients lung and heart transplant may need to be performed together.

Lung failure requiring transplant can be caused by

Your lungs make sure that your body receives the oxygen it needs to survive. When your lungs are damaged due to disease or injury, they are unable to perform this essential function. Damage that may require transplantation can be caused by

• Chronic Obstructive Pulmonary Disease (COPD): A Chronic inflammatory lung disease that causes obstruction in the airflow from the lungs. Stage 4 (very severe) of COPD is a condition where your airflow is severely limited and there are frequent flare-ups requiring external intervention and hospitalization. Quality of life is very poor. Your doctor may recommend transplant as the ultimate treatment option.
• Pulmonary fibrosis (Scarring of lungs): This is a condition where the lungs become scarred over time. The cause could be long-term exposure to toxins like asbestos, coal dust or silica. Some medications are known to have the side effect of pulmonary fibrosis. The condition is progressive and cannot be reversed. Treatment can, however, slow the progression. When a patient reaches the 4^th stage of pulmonary fibrosis, the doctor may recommend transplant to improve quality of life.
• Pulmonary hypertension (high blood pressure in the lungs): High blood pressure in the arteries of the lung is a condition that may be an offshoot of congenital heart disease, connective tissue diseases, coronary artery disease, high blood pressure, liver cirrhosis, or other lung conditions like blood clots or emphysema. Treatment of the condition is related to

Lung damage is usually treated with medications and special breathing devices in the earlier stages and as the disease progresses. However, when these forms of treatment no longer give relief and the condition becomes life-threatening, the doctor would advice Lung Transplant. Depending on the severity and extant of spread of the disease single or both lungs may need to be transplanted.

Patients with cardiac conditions may need a heart procedure prior to the transplant. In patients with severe, life threatening heart conditions a combined heart-lung transplant may be recommended. The success rates of the surgery are usually good. The patient would, however, need to work with the clinical and rehab teams in ensuring the success and be willing to make the necessary lifestyle changes like quitting smoking and consuming alcohol, follow regular exercise and balanced diet routines.

Lung transplant is usually not recommended in the following situations:

• If you have an active infection
• If you have recent medical history of cancer
• If you have serious kidney, liver or heart disease
• If you are unwilling to make the recommended lifestyle changes and do not have a support network at home

Possible Risks

• Risk of rejection: This is the result of your own immune system treating the newly implanted lung as an enemy and attacking it causing your body to reject it. Immunosuppressant medications are prescribed by doctors to prevent this. The risk of rejection is the greatest immediately after the transplant surgery, and reduces with time. You shall need regular check-ups and need to take the anti-rejection drugs prescribed for the rest of your life.
• Anti-rejection drugs may cause some side-effects in certain people like weight gain, facial hair and stomach problems. They may also aggravate certain pre-existing medical conditions like diabetes, kidney damage, osteoporosis or cancer, however the same can be monitored and controlled with your doctor’s advice.
• Increased risk of infections: Immunosuppressant medications can make you more vulnerable to infections. To counter this follow certain safety precautions like
• Wash your hands frequently
• Maintain strict dental hygiene
• Protect your skin from scratches or sores
• Avoid crowds
• Maintain your vaccination schedules

Preparing for the transplant

Choosing the centre for your transplant is the first and most important step. The lung transplant centre should be comprehensively equipped with an experienced team and advanced critical care and rehab facilities.

At the centre you will be evaluated by the clinical team.

• A physical evaluation will be conducted to understand your lung condition and other medical conditions that you may have. Certain health parameters will also need to be evaluated for which you shall need to undergo certain tests
• Your mental health status will also be evaluated by trained specialists and counselors
• You will be counseled about the entire process, possible risks and side-effects will be discussed with you
• You will also be evaluated on the home support system available to you and your willingness to adhere to recommended lifestyle changes pre and post transplant

Waiting for a donor

If the doctors decide that you are a candidate for lung transplant surgery, your name will be registered on the waiting list for a donor lung. The priority given would depend largely on your condition and urgency for transplant. You and your family shall need to be prepared for a long wait – sometimes months and years.

As you wait you will be constantly monitored by the doctors. Your treatment may be altered for better results. You will be recommended certain lifestyle changes that will include dietary modifications and exercise routines to help you deal with your condition better.

Your doctor may also recommend pulmonary rehab to enable you to manage your symptoms better as you wait.

How is a donor match determined?

Donor match will depend upon:

• Blood type
• Size of the organ and the chest cavity
• Geographical distance between donor and recipient
• Recipient’s current health condition and severity of her/his disease

Always be ready!

You will have to be mentally prepared to receive the call informing you about the availability of a donor any time of day or night. Be ready to move as soon as you receive the call. Once you reach your transplant centre you shall have to undergo certain evaluations to check for you current condition and readiness for the surgery. The doctors will evaluate the donor lung also to ensure it is healthy and a good match for you.

The Procedure

The surgery will be performed under general anaesthesia. A tube guided through your mouth to the windpipe will enable you to breathe. The surgeon will cut open your chest cavity and take out the diseased lung. The main airway to the lung and the blood vessels connected to the heart will then be connected to the donor lung. Some patients may need the support of an external heart-lung bypass machine to enable continuous circulation of oxygenated blood.

Read about ECMO

Post Surgery

You shall be shifted to the critical care unit post transplant and shall require ventilator support for the initial few days. As your condition gradually improves you shall be weaned off the ventilator and moved to a step down unit (high dependency unit or HDU) and then to the ward. In the ward the pulmonary rehab team will work with you to help you return to normalcy. Your hospital stay post transplant could be up to three weeks. After discharge you will need to stay close to the hospital/transplant centre as you will need regular monitoring for signs of rejection or any other complication. You shall need to undergo chest x-ray, blood tests, lung function tests, lung biopsy and ECG during your follow up visits. With passing time the frequency of follow-ups would reduce

Life-long Care Plan post Transplant

You will be required to make a number of lifestyle adjustments to ensure the success of your transplant

Immunosuppressant medications will become an essential part of your daily routine

Medications and checking lung function– needs to become a routine you follow every day

Lifestyle adjustments – diet, exercise, not using tobacco products, limiting alcohol are four very important adjustments you shall need to make

Emotional support – Support at home is very important for a transplant patient. Life after transplant is a big adjustment and emotions like anxiety, depression are common. You shall need the support of your friends and family and may also need help from an external support group. Speak to your doctor you feel you are not being able to cope.

Medica’s Lung Transplant Programme

Among the most advanced in the region, Medica’s Lung Transplant Programme comprises highly skilled surgeons, critical care specialists, specially trained nurses and technicians, along with a pulmonary rehab and nutritionists’ team. Dedicated operation theatres and critical care unit fitted with latest life support and monitoring technology, provide comprehensive coverage and post transplant support. We also facilitate air-ambulance transfer of critical patients, nationally and internationally.