Lung Transplant

When your lungs don’t function properly, it can result in respiratory failure. This occurs when either:

• enough oxygen does not pass into your blood from your lungs (low oxygen levels). This condition is called hypoxemia.

• your lungs are not able to remove the carbon di oxide in your blood efficiently (high levels of carbon di oxide). This condition is called hypercapnia

Both these problems can occur simultaneously.

Diseases resulting in lung failure⁷

If your lungs can no longer perform the vital functions of exchanging oxygen and carbon di oxide in your blood, and your lungs are too diseased to be medically managed, you will require a lung transplant. You will often require continuous oxygen and will experience extreme fatigue from the lack of oxygen.

Diseases that can lead to lung failure include:

• Chronic Obstructive Pulmonary Disease (COPD): COPD can be caused by asthma, chronic bronchitis or emphysema
• Alpha-1 antitrypsin deficiency: A hereditary condition in which a lack of alpha-1 antitrypsin—a protein that protects the lungs—results in early-onset lung disease.
• Interstitial Lung Disease (ILD): This is a general term that includes a variety of chronic lung disorders such as idiopathic pulmonary fibrosis, sarcoidosis, eosinophilic granuloma, Goodpasture’s syndrome, idiopathic pulmonary hemosiderosis and Wegener’s granulomatosis.
• Bronchiectasis: This is the irreversible widening of the airways. As airways widen, they become less rigid and more prone to collapse. It also becomes more difficult to clear away secretions. Bronchiectasis can be present at birth, or it can develop later as a result of injury or other diseases (most often cystic fibrosis).
• Cystic fibrosis: is a genetic disease where patients often have respiratory problems including bronchitis, bronchiectasis,  pneumonia, sinusitis (inflammation of the sinuses), nasal polyps (growths inside the nose), or pneumothorax (collapsed lung).

If you have been diagnosed with lung failure, to be suitable for a lung transplant:

• your other organs, such as kidneys and liver, must work normally
• if you smoke, you must have stopped smoking
• if you drink alcohol, you will be encouraged to stop
• you must be willing to take care of your new lungs.

A team of transplant doctors will assess your eligibility for a transplant, and if you are suitable and willing to have a transplant, you will be put on a waiting list.

When a suitable donor is available, you will be called to have a lung transplant. To see more on transplant waiting lists and allocation of organs click here

You will be placed on the waiting list for a transplant found you suitable for a transplant and have obtained your consent. At any point while you are waiting, you have the choice to decide not to go ahead with the transplant. The transplant team may also take you off the list or put you on hold for medical reasons. These reasons will be explained to you.

While on the waiting list, you must have a monthly blood samples sent out to the Australian Red Cross Transplantation services for antibody tissue test to be carried out.

Ensure that you are contactable at ALL TIMES on telephone or mobile phone. If you are going on a holiday, or have been admitted/discharged from the hospital, please notify your transplant coordinator.

The Transplant Society of Australia and New Zealand (TSANZ) have specific criteria that determine if you would be eligible to be on the waiting list.

Below is some information on the criteria as specified in the TSANZ protocol for you to be put on the waiting list. For more information, please click here.

Inclusion Criteria

• Respiratory failure despite optimal medical therapy, intervention and surgical treatment and/or;
• Poor quality of life, potentially with intractable symptoms and repeat hospital admissions.

Exclusion Criteria

• Active malignancy
• Irreversible dysfunction of organs or other body systems- combined organ transplant may be considered.
• Non – curable chronic infection
• Documented non-adherence or inability to comply with complex medical therapy or follow up.
• Substance addiction that is either active or within the last 6 months – cigarettes, alcohol and drugs.

• While you are waiting for your transplant you need to think about a few things that will make it easier to manage your life after your transplant.You will need to attend the transplant clinic every day after your surgery and progressively less frequently for at least a period of 3 months. Depending on your progress, you may be required to stay longer. Think about:
  • How you will travel to and from the clinic during this time
  • Accommodation during this period if you are a rural patient
  • Accessing IPTAAS (Isolated Patients Transport and Accommodation Assistance Scheme for those staying in NSW) or equivalent in other states (VTAAS etc)
  • Taking time off work, if you are in the workforce
  • What you will need to carry with you if you are going to stay away from home during this period
  • Care for your dependents (children or pets) while you are away                  

The call!

When there is a possibility of a transplant, you will receive a call. You can receive this call any time of the day or week. Your transplant unit will advise you on what you need to do when you receive the call. It is exciting to be on your way to a new beginning to your life.  Also receiving a call does not guarantee that you will be receiving the transplant, as a number of factors may result in the organ not being suitable for you (e.g. you may be unwell with a viral infection or flu).

A lung transplant operation can take from 4 up to 8 hours. This depends on your medical condition, any previous heart or lung surgery and the condition of the donor organs.

At the time of the surgery, each of your lungs will be removed separately one at a time, the transplant of the donor lungs will take place one at a time.  The large airways and blood vessels will be connected back, but the surgeon cannot connect back the nervous system during transplant surgery. This is called “denervation”.⁹ Your new lungs will be able to perform the exchange of oxygen and carbon dioxide efficiently, and have near normal lung function with time following rehabilitation after surgery.

After your surgery you will remain in ICU and monitored closely, and will be moved to the ward when you no longer need intensive care.

Medications

After your transplant you will immediately start taking a host of medications to keep your new organ healthy. These medicines will keep your immunity low, so that your body does not reject the new lungs. Over time, the doses of the medicines will drop but you will have to take them throughout the life of your transplant.

Ensure you always have a ready supply of medications especially when you are travelling because these medications are not available easily. Ensure you carry a doctor’s letter if travelling overseas.  In many instances, you will need to keep track of all your medication spending through the Pharmaceutical Benefits Scheme.  Once you reach a certain limit each year, the price of the medicines will be significantly reduced or free (e.g. for those with a Health Benefits card or a Pensioner Concession Card).

Discharge from hospital

Your hospital stay can last from 10 – 14 days depending on the post-operative complications that can extend your stay. Your transplant nurses will encourage you to mobilise quickly to aid your recovery.

You will have physio sessions in the hospital to help mobilise you and get you ready for discharge.

Discharge from hospital is often an exciting and significant step in your road to recovery.  A lot has gone on behind the scenes to ensure you have been able to receive this transplant, enabling you to regain your health or improve your quality of life.

Blood tests and monitoring

You will be required to visit your doctor on a regular basis.  Initially you will need to visit the hospital for tests every day for up to a month and then less frequently over time. If seeing multiple doctors for different things, please ensure that all doctors know what medications you are taking.  Some medicines do interact with other medications, and must be taken with care.

For at least a few weeks afterwards, do not over-do things.  But also do not lounge around all day.  The aim of the transplant is for you to return to a normal life style. Start socialising with friends, family and meeting new people as soon as you feel well enough.

Healthy lifestyle

Once your new lung start working, let good nutrition and exercise be part of your healthy lifestyle. Everything and anything in moderation until you are completely stable.

• Avoid foods that may interact adversely with your medication.
• Maintain good food hygiene while preparing your meals.
• Maintain a high level of personal hygiene, including dental hygiene
• Clean open wounds and cuts with antiseptic. Consult your GP if your wound becomes red and painful.
• Always check with your immunologist if another doctor suggests you should receive any immunisations. The Mantoux test for tuberculosis and immunisations for yellow fever for example are forbidden as are any other immunisations using live or weakened bacteria or viruses.  However, influenza vaccinations or immunoglobulins are okay.

Reduce the risk of infection by maintaining your hygiene and reporting symptoms early. If possible, avoid coming into contact with people who have the cold or the flu. Avoid coming into close contact with children or people with chicken pox or measles and other viral and bacterial infections.

For more on caring for your new lung after discharge and the precautions to take, please refer to the section on “After your Transplant”.

Stages of returning to activity, including work

Resuming normal activities gradually, only if you feel up to it.  Engage in normal activities like catching the bus and going to the movies, and attending parties.

It is recommended you start slowly in the first instance.  This also includes sexual activity. If in doubt, ask your doctor.  Don’t be shy – they have heard it all before.

Returning back to work is a big step and you should carefully consider and plan your return well in advance. Consult with your transplant team before you resume work. There may aspects of your job that you may not be able to resume immediately or even in the near future. Please refer to the section on “life Skills” (Place link here)

Driving after Transplant Surgery

You may wish to resume driving as soon as possible after your surgery. You must check with your doctor to clarify when it is safe to drive. You can resume driving after six weeks post-transplant depending on the type of surgery you have had and the size of the wound. Before driving, ensure that your wound is healing well, that you are alert and not fatigued, no longer experiencing significant pain or taking medications that can cause drowsiness.

For information on assessing fitness to drive, please visit the website www.austroads.com.au . The guidelines on this website outline the responsibility drivers, health professionals and the licensing authorities. The rules for driving are very clear and are set out to protect you, the transplant doctors and the general public.

Respect your new organ 

Smoking is severely damaging to the transplant lungs and will decrease long term survival. Do not smoke!

During the first few months after the surgery it is advisable not to consume any alcohol as you are monitored for drug levels and liver and kidney functions. After 3 months, once your transplant nurse and dietician approve, you can have alcohol in moderation. Two standard drinks per day is usually acceptable.

1. http://www.livescience.com/52250-lung.html
2. How the Lungs Work: American Lung Association. http://www.lung.org/lung-health-and-diseases/how-lungs-work/?referrer=https://www.google.com.au/ viewed on 1 July 2016
3. Respiratory Failure: The Free Dictionary  http://medical-dictionary.thefreedictionary.com/Lung+failure Link viewed on 1 July 2017
4. What is respiratory failure: National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/rf Link viewed on 1 July 2017
5. What Causes Respiratory Failure: National Heart Lung and Blood Institute https://www.nhlbi.nih.gov/health/health-topics/topics/rf/causes Link viewed on 1 July 2017
6. http://www.webmd.com/lung/lung-diseases-overview?page=2
7. Reasons you might need a Lung Transplant: EMORY Healthcare http://www.emoryhealthcare.org/transplant-lung/learn-about/why-needed.html Link viewed on 4th July 2016
8. Clinical Guidelines for Organ Transplantation from Deceased Donors: Version 1.0 April 2016. The Transplantation Society of Australia and New Zealand; https://www.tsanz.com.au/downloads/TSANZ%20Clinical%20Guidelines%20for%20Organ%20Transplantation%20from%20Deceased%20Donors_Version%201.0_April%202016.pdf website viewed on July 4 2016
9. Information manual for Heart, Heart Lung and Lung recipients: Heart Lung Transplant Unit; St Vincent’s Hospital.