QUESTIONS | ANSWERS
Q: What is a lung transplant?
A lung transplant is a surgical procedure that involves replacing diseased lungs with healthy lungs from deceased donors. The decision to perform a single or double lung transplant depends on a number of complex factors – including your type of lung disease, and your unique clinical situation.
Following transplant surgery, you’ll be put on a lifelong regimen of medications. This includes immunosuppressant anti-rejection and anti-infection medications designed to keep you, and your new lungs, healthy. Other medications may be added as needed to address your current – and future – health conditions.
Q: Who needs a lung transplant?
If you have severe and progressive lung disease, your doctor may recommend that you undergo a complex evaluation process to see if you’ll benefit from a transplant. You’ll be more likely to receive a transplant if you have no serious medical problems, excellent health habits, and family and/or friends who can help with your post-transplant care.
Examples of severe lung disease include chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF) or many other types of pulmonary fibrosis, cystic fibrosis (CF), alpha-1 antitrypsin deficiency-related emphysema, and pulmonary hypertension (PH).
Q: How long is the typical wait for a donor lung?
The waiting time varies significantly across the country. In the New York region, most patients wait 10 -14 months for their replacement organ(s) to become available, depending on their blood type. However, since the list is also based on medical urgency, your place on the list may fluctuate due to health changes and the addition or removal of other patients on the waiting list.
Q: Are all donor lungs suitable for transplant?
Once members of your transplant surgical team have been notified that a donor lung is available, they will evaluate whether the organ is suitable for transplant. Unfortunately, more often than not, your donor lung will be deemed damaged or infected upon inspection. In that case, your long-awaited for surgery will be cancelled and you’ll be sent home. This is why research into lung rehabilitation is so critical. The more lungs that can be rehabilitated, the more people will benefit.
Q: What kind of medication is given after a transplant?
Immediately following surgery, you’ll be prescribed a combination of anti-rejection drugs. The good news is that these medications – also called immunosuppressive or immunosuppressant drugs – may reduce the likelihood that your immune system will reject your new lungs. The bad news is that episodes of rejection still commonly occur, and many patients end up developing chronic lung rejection. What’s more, by suppressing your immune system, these drugs can also make you more vulnerable to different types of infections, as well as certain kinds of cancer.
Q: Do post-transplant medications have serious side effects?
Since post-transplant medications must be taken for life, it is important to understand what to expect in terms of side effects. In addition to increasing your risk of infection, some of these drugs may cause hypertension, diabetes, hyperlipidemia, chronic kidney disease, low cell counts, weight gain, and gastrointestinal problems. Fortunately, research is being done to develop safer drugs that can reduce or even eliminate these significant, and sometimes, life-threatening side effects.
Q: Is organ rejection a common risk of lung transplant surgery?
Despite the use of anti-rejection drugs, almost all patients have one or more episodes of acute rejection following their transplant. When this occurs, it is caused by your immune system and is associated with inflammation around the vessels and airways of your new lung(s). Thankfully, this type of rejection can generally be treated with stronger anti-rejection medications. However, this means your immune system will be even more suppressed than before.
Once you’ve had one episode of acute rejection, you can be susceptible to developing chronic lung allograft dysfunction (CLAD). In most cases, CLAD is caused by chronic rejection. Unlike acute rejection, chronic rejection is very difficult to treat and often causes a progressive loss of lung function. Once diagnosed, stronger immunosuppressive protocols can be tried. However, response rates are low and complications are high. Sadly, chronic lung infection is responsible for more than 50% of the deaths that occur during the first five years after surgery.
Q: Why do post-transplant infections occur and what can be done?
There are many reasons why organ transplant and infection often go hand in hand. First, because anti-rejection medications are designed to suppress your immune system, you are already at a heightened risk for infection following surgery. Second, every time you take a breath, you’re exposed to a multitude of irritating inhalants and pathogens – any one of which can cause dangerous bacterial, viral or fungal infections. Third, your lungs can be invaded by infections from sources already inside you – including your sinuses, upper respiratory tract, and upper gastrointestinal tract.
Although medications can be prescribed to prevent or decrease the spread of some of these “opportunistic” infections, they’re not always effective or tolerated. For this reason, new strategies are desperately needed to help keep patients rejection free – as well as infection free. Right now, researchers are exploring the possibility of “transplant immune tolerance” – i.e. a state in which the immune system sees the transplanted organ as one of its own, instead of an outsider that has to be destroyed. Research to achieve transplant immune tolerance link to tolerance is essential to enhance post-transplant quality of life and outcomes.
Q: How can I help make a difference?
When you make a tax-deductible donation link to 2.1.1. – donation form to the Lung Transplant Project, you’ll be funding the research that is so desperately needed to reduce lung transplant waiting lists, improve donor lung rehabilitation, and lower post-transplant infection and rejection rates. If you’ve had a lung transplant, or you know some who has, you can inspire others to get involved by offering to share your story. link to story submission page. We’d love to hear from you.