Lung Transplant

A lung transplant is a surgical procedure that replaces diseased lungs with healthy lungs from a donor.

Lung transplantation s a treatment option for people with severe, end-stage lung diseases including COPD, cystic fibrosis and pulmonary fibrosis.

A lung transplant is a major operation with potential risks, including rejection. Working with a team of health care providers who specialize in lung transplantation is essential to understand your options.

Whether you or a loved one is grappling with end-stage lung disease, cystic fibrosis, COPD, lung cancer, or other severe respiratory disorders, our expert team at WashU Medicine provides comprehensive and compassionate care.

Who needs a lung transplant?

Lung transplants are primarily considered for patients with end-stage lung disease, including:

• Cystic fibrosis: A genetic disorder affecting the lungs and other organs.
• Chronic obstructive pulmonary disease (COPD): A progressive lung disease that makes breathing difficult.
• Lung cancer: Advanced stages may necessitate a transplant if other treatments are not viable.
• Other respiratory disorders: Conditions such as idiopathic pulmonary fibrosis (IPF).

Screening

Candidates for lung transplant undergo a rigorous screening process to be sure they are best suited for transplantation.

Screening may include:

• Detailed medical history and physical examination
• Pulmonary function tests and imaging studies (such as CT scans)
• Blood tests to assess organ function and overall health
• Psychological evaluation to ensure emotional readiness

The purpose of screening is to ensure that each candidate is in optimal condition to benefit from a lung transplant.

Donor matching

Lung transplantation is a complex and delicate procedure. Finding the right donor match is a critical component to ensuring a successful transplant.

Key factors in donor matching

Blood type compatibility

One of the primary criteria in donor matching is blood type compatibility. The donor and recipient must share a compatible blood type to reduce the risk of immune rejection. Blood type matching is essential to ensure the recipient’s body accepts the new lung with minimal complications.

Tissue typing (HLA matching)

Human leukocyte antigen (HLA) matching involves comparing specific proteins on the surface of cells between the donor and the recipient. The closer the HLA match, the lower the risk of rejection. Although perfect matches are rare, partial HLA matching is crucial to improving transplant success rates.

Size matching

The size of the donor lung must be appropriate for the recipient’s body. Lungs that are too large or too small can lead to complications such as difficulty breathing or inadequate oxygenation. Therefore, we carefully evaluate the size compatibility to ensure the lung fits well within the recipient’s chest cavity.

Age and health condition of donor

The age and overall health of the donor are also essential considerations. Generally, younger donors and those with healthy lung function are preferred as they tend to provide better outcomes. At WashU Medicine, we thoroughly assess the donor’s medical history to ensure the lungs are in optimal condition for transplantation.

Managing medication and recovery

After transplant, patients must adhere to a strict medication regimen to prevent organ rejection and infections.

Our team at WashU Medicine provides extensive education on managing medication and closely monitors patients during the critical recovery period.

Potential complications and care after transplant

While lung transplants can significantly improve quality of life, they do come with risks. Potential complications include infection, rejection and recurrence of the underlying disease.

After a lung transplant, care includes:

• Regular follow-up appointments
• Pulmonary rehabilitation to regain strength and respiratory function
• Ongoing support from our transplant care team

Graft rejection

Graft rejection is a significant risk following a lung transplant and can occur when the recipient’s immune system recognizes the transplanted lung as foreign and attempts to attack it. This is a natural response of the immune system but poses a serious threat to the success of the transplant.

There are three primary types of graft rejection:

• Hyperacute rejection: This type occurs within minutes to hours after the transplant when pre-existing antibodies in the recipient attack the graft. It is rare but often fatal if it occurs.
• Acute rejection: Acute rejection happens within the first few weeks to months after a transplant. Approximately 25-30% of lung transplant recipients experience acute rejection. Symptoms may include shortness of breath, cough, fever, and a decline in lung function.
• Chronic rejection (bronchiolitis obliterans syndrome or BOS): This is a major long-term challenge for lung transplant recipients, typically occurring months to years after the transplant. It leads to a gradual decline in lung function due to inflammation and scarring of the airways.

Managing graft rejection

• Immunosuppressive medications: To prevent and manage graft rejection, patients are prescribed immunosuppressive medications. These drugs reduce the activity of the immune system, minimizing the chances of rejection. It is crucial for recipients to adhere strictly to their medication regimen to maintain the health of the transplanted lung.
• Monitoring and follow-up: Regular follow-up appointments are essential for early detection and management of rejection. This often involves various tests, such as:
  • Lung function tests
  • Chest X-rays or CT scans
  • Bronchoscopy with biopsy to detect cellular changes indicative of rejection
• Lifestyle and support: Adopting a healthy lifestyle, including avoiding infections, not smoking, eating a balanced diet, and engaging in recommended physical activity, can also help manage the risk of graft rejection. Psychological and emotional support is equally important to ensure the patient’s overall well-being.

Graft rejection is a serious concern following a lung transplant, but with the expert care team at WashU Medicine, we strive to mitigate these risks through comprehensive monitoring and treatment protocols. Our goal is to help you achieve the best possible outcome and enjoy a better quality of life after transplantation.