A lung transplant removes a person's diseased lung and replaces it with a healthy one. The healthy lung comes from a donor who has died. Some people get one lung during a transplant. Other people get two.

Lung transplants are used for people who are likely to die from lung disease within 1 to 2 years. Their conditions are so severe that other treatments, such as medicines or breathing devices, no longer work. Lung transplants most often are used to treat people who have severe:

• COPD
• Cystic fibrosis
• Idiopathic pulmonary fibrosis
• Alpha-1 antitrypsin deficiency
• Pulmonary hypertension

Complications of lung transplantation include rejection of the transplanted lung and infection.

Your doctor may recommend a lung transplant if you have severe lung disease that's getting worse. If your condition is so serious that other treatments don't work, a lung transplant may be the only option.

Lung transplants most often are used to treat people who have severe:

• COPD (chronic obstructive pulmonary disease). COPD is the most common reason why adults need lung transplants. COPD is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time.
• Idiopathic pulmonary fibrosis (IPF). IPF is a condition in which tissue deep in your lungs becomes thick and stiff, or scarred, over time.
• Cystic fibrosis (CF). CF is the most common reason in children for needing a lung transplant. CF is an inherited disease that causes thick, sticky mucus to build up in the lungs. This leads to repeated, serious lung infections.
• Alpha-1 antitrypsin deficiency (AAT deficiency). AAT deficiency is a condition that raises your risk for certain types of lung disease, especially if you smoke.
• Pulmonary hypertension (PH). PH is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen.

Applying to a Lung Transplant Program

Lung transplants are done in medical centers (large hospitals) where the staff has a lot of organ transplant experience. If you need a lung transplant, you must apply to a center's transplant program.

Transplant teams at the medical center manage all parts of the center's transplant program. Transplant team members may include a:

• Thoracic (THOR-as-ik) surgeon. This is a doctor who does lung and chest surgeries.
• Pulmonologist. This is a doctor who specializes in lung diseases and conditions.
• Cardiologist. This is a doctor who specializes in heart diseases and conditions.
• Immunologist. This is a doctor who specializes in immune system disorders.
• Respiratory (RES-pi-rah-tor-e) technician. This is a person who cares for people who have breathing and lung problems.
• Transplant coordinator. This is a person who arranges the surgery.

Other team members may include a social worker, psychiatrist, financial coordinator, and other specialists and medical personnel, such as a nutritionist and nurses.

The transplant team will need to find out whether you're a candidate for a lung transplant. They will want to make sure you're healthy enough to have the surgery and go through a recovery program.

To do this, they will ask about your medical history. The team will want to know whether you have other serious illnesses or conditions, such as cancer, HIV, or hepatitis. They also will ask whether you've had a major chest surgery. A previous chest surgery may make it hard to do a lung transplant.

The team also will want to know whether you smoke or use alcohol or drugs.

You also will have tests to show whether you're healthy enough for a lung transplant. Tests may include:

• Lung function tests. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.
• Blood tests. Blood tests help doctors check for certain diseases and conditions. They also help check the function of your organs and show how well treatments are working.
• Chest CT scan. This test creates precise pictures of the structures inside your chest, such as your lungs.
• EKG (electrocardiogram). This test detects and records the heart's electrical activity.
• Echocardiography (echo). Echo uses sound waves to create pictures of your heart.
• Right cardiac catheterization. This test measures blood pressure in the right side of your heart. The results give clues about heart valve disease, heart failure, or lung problems.

You'll talk with team members to make sure you're mentally and emotionally willing to accept the risks of the transplant process and later treatment. The team may ask whether you have a good support network of family and friends.

Alpha-1 antitrypsin deficiency is an inherited condition that causes low levels of, or no, alpha-1 antitrypsin in the blood.

What is alpha-1 antitrypsin deficiency?

Alpha-1 antitrypsin deficiency (AATD) is an inherited condition that causes low levels of, or no, alpha-1 antitrypsin (AAT) in the blood. AATD occurs in approximately 1 in 2,500 individuals. This condition is found in all ethnic groups; however, it occurs most often in whites of European ancestry.

Alpha-1 antitrypsin (AAT) is a protein that is made in the liver. The liver releases this protein into the bloodstream. AAT protects the lungs so they can work normally. Without enough AAT, the lungs can be damaged, and this damage may make breathing difficult.

Everyone has two copies of the gene for AAT and receives one copy of the gene from each parent. Most people have two normal copies of the alpha-1 antitrypsin gene. Individuals with AATD have one normal copy and one damaged copy, or they have two damaged copies. Most individuals who have one normal gene can produce enough alpha-1 antitripsin to live healthy lives, especially if they do not smoke.

People who have two damaged copies of the gene are not able to produce enough alpha- 1 antitrypsin, which leads them to have more severe symptoms.

What are the symptoms of AATD?

Alpha-1 antitrypsin deficiency (AATD) can present as lung disease in adults and can be associated with liver disease in a small portion of affected children. In affected adults, the first symptoms of AATD are shortness of breath with mild activity, reduced ability to exercise and wheezing. These symptoms usually appear between the ages of 20 and 40. Other signs and symptoms can include repeated respiratory infections, fatigue, rapid heartbeat upon standing, vision problems and unintentional weight loss.

Some Individuals with AATD have advanced lung disease and have emphysema, in which the small air sacs (alveoli) in the lungs are damaged. Symptoms of emphysema include difficulty breathing, a hacking cough and a barrel-shaped chest. Smoking or exposure to tobacco smoke increases the appearance of symptoms and damage to the lungs. Other common diagnoses include COPD (chronic obstructive pulmonary disease), asthma, chronic bronchitis and bronchiectasis - a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles.

Liver disease, called cirrhosis of the liver, is another symptom of AATD. It can be present in some affected children, about 10 percent, and has also been reported in 15 percent of adults with AATD. In its late stages signs and symptoms of liver disease can include a swollen abdomen, coughing up blood, swollen feet or legs, and yellowing of the skin and the whites of the eyes (jaundice).

Rarely, AATD can cause a skin condition known as panniculitis, which is characterized by hardened skin with painful lumps or patches. Panniculitis varies in severity and can occur at any age.

How is AATD diagnosed?

Alpha-1 antitrypsin deficiency (AATD) is diagnosed through testing of a blood sample, when a person is suspected of having AATD. For example, AATD may be suspected when a physical examination reveals a barrel-shaped chest, or, when listening to the chest with a stethoscope, wheezing, crackles or decreased breath sounds are heard.

Testing for AATD, using a blood sample from the individual, is simple, quick and highly accurate.. Three types of tests are usually done on the blood sample:

• Alpha-1 genotyping, which examines a person's genes and determines their genotype.

• Alpha-1 antitrypsin PI type of phenotype test, which determines the type of AAT protein that a person has.

• Alpha-1 antitrypsin level test, which determines the amount of AAT in a person's blood.

Individuals who have symptoms that suggest AATD or who have a family history of AATD should consider being tested.

What is the treatment for AATD?

Treatment of alpha-1 antitrypsin deficiency (AATD) is based on a person's symptoms. There is currently no cure. The major goal of AATD management is preventing or slowing the progression of lung disease.

Treatments include bronchodilators and prompt treatment with antibiotics for upper respiratory tract infections. Lung transplantation may be an option for those who develop end-stage lung disease. Quitting smoking, if a person with AATD smokes, is essential.

Replacement (augmentation) therapy with the missing AAT protein is available, although it is used only under special circumstances. It is not known how effective this is once disease has developed or which people would benefit most.

Is AATD inherited?

Alpha-1 antitrypsin deficiency (AATD) is inherited in families in an autosomal codominant pattern. Codominant inheritance means that two different variants of the gene (alleles) may be expressed, and both versions contribute to the genetic trait.

The M gene is the most common allele of the alpha-1 gene. It produces normal levels of the alpha-1 antitrypsin protein.

The Z gene is the most common variant of the gene. It causes alpha-1 antitrypsin deficiency. The S allele is another, less common variant that causes ATTD.

If a person inherits one M gene and one Z gene or one S gene ('type PiMZ' or 'type PiMS'), that person is a carrier of the disorder. While such a person may not have normal levels of alpha-1 antitrypsin, there should be enough to protect the lungs. However, carriers with the MZ alleles have an increased risk for lung disease, particularly if they smoke.

A person who inherits the Z gene from each parent is called 'type PiZZ.' This person has very low alpha-1 antitrypsin levels, allowing elastase - an enzyme especially of pancreatic juice that digests elastin - to damage the lungs. A person who inherits an altered version called S and Z is also likely to develop AATD.

What is COPD?

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis.

What are the symptoms of COPD?

Symptoms of COPD include:

• Frequent coughing or wheezing.
• Excess phlegm, mucus, or sputum production.
• Shortness of breath.
• Trouble taking a deep breath.

Who has COPD?

Chronic lower respiratory disease, primarily COPD, was the third leading cause of death in the United States in 2014. Almost 15.7 million Americans (6.4%) reported that they have been diagnosed with COPD. More than 50% of adults with low pulmonary function were not aware that they had COPD, so the actual number may be higher. The following groups were more likely to report COPD in 2013.

• Women.
• People aged 65 to 74 years and ≥75 years.
• American Indians/Alaska Natives and multiracial non-Hispanics.
• People who were unemployed, retired, or unable to work.
• People with less than a high school education.
• People who were divorced, widowed, or separated.
• Current or former smokers.
• People with a history of asthma.

What causes COPD?

In the United States, tobacco smoke is a key factor in the development and progression of COPD. Exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role. In the developing world, indoor air quality is thought to play a larger role than it does in the United States. People should try to avoid inhaling tobacco smoke, home and workplace air pollutants, and respiratory infections to prevent developing COPD. Early detection of COPD may change its course and progress.

What are the complications or effects of COPD?

Compared to adults without COPD, those with this disease are more likely to:

• Have activity limitations like difficulty walking or climbing stairs.
• Be unable to work.
• Need special equipment like portable oxygen tanks.
• Not engage in social activities like eating out, going to places of worship, going to group events, or getting together with friends or neighbors.
• Have increased confusion or memory loss.
• Have more emergency room visits or overnight hospital stays.
• Have other chronic diseases like arthritis, congestive heart failure, diabetes, coronary heart disease, stroke, or asthma.
• Have depression or other mental or emotional conditions.
• Report a fair or poor health status.

How is COPD diagnosed?

A simple test, called spirometry, can be used to measure pulmonary—or lung—function and detect COPD in anyone with breathing problems.

How is COPD treated?

Treatment of COPD requires a careful and thorough evaluation by a physician. COPD treatment can alleviate symptoms, decrease the frequency and severity of exacerbations, and increase exercise tolerance. Treatment options that your physician may consider include:

• Quit smoking. For people who smoke, the most important part of treatment is smoking cessation.
• Avoid tobacco smoke and other air pollutants at home and at work.
• Ask your doctor about pulmonary rehabilitation, which is a personalized treatment program that teaches COPD management strategies to improve quality of life. Programs may include plans that teach people how to breathe better and conserve their energy, as well as provide advice on food and exercise.
• Take medication. Symptoms such as coughing or wheezing can be treated with medication.
• Avoid lung infections. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumococcal vaccines, are especially important for people with COPD. Respiratory infections should be treated with antibiotics, if appropriate.
• Use supplemental oxygen. Some people may need to use a portable oxygen tank if their blood oxygen levels are low.

Cystic fibrosis (CF) is the most common, fatal genetic disease in the United States. About 30,000 people in the United States have the disease. CF causes the body to produce thick, sticky mucus that clogs the lungs, leads to infection, and blocks the pancreas, which stops digestive enzymes from reaching the intestine where they are required in order to digest food.

What do we know about heredity and cystic fibrosis?

Mutations in a single gene - the Cystic Fibrosis Transmembrane Regulator (CFTR) gene - causes CF. The gene was discovered in 1989. Since then, more than 900 mutations of this single gene have been identified.

In normal cells, the CFTR protein acts as a channel that allows cells to release chloride and other ions. But in people with CF, this protein is defective and the cells do not release the chloride. The result is an improper salt balance in the cells and thick, sticky mucus. Researchers are focusing on ways to cure CF by correcting the defective gene, or correcting the defective protein.

Gene Therapy Research Offers Promise of a Cure for Cystic Fibrosis

Gene therapy offers great promise for life-saving treatment for CF patients since it targets the cause of CF rather than just treating symptoms. Gene therapy for CF had its start in 1990, when scientists successfully corrected faulty CFTR genes by adding normal copies of the gene to laboratory cell cultures.

In 1993, the first experimental gene therapy treatment was given to a patient with CF. Researchers modified a common cold virus to act as a delivery vehicle - or "vector"- carrying the normal genes to the CFTR cells in the airways of the lung.

Subsequent studies have tested other methods of gene delivery, such as fat capsules, synthetic vectors, nose drops or drizzling cells down a flexible tube to CFTR cells lining the airways of lungs. Researchers are now testing aerosol delivery using nebulizers.

But finding the best delivery system for transporting normal CFTR genes is only one problem that scientists must solve to develop an effective treatment for CF. Scientists must also determine the life span of affected lung cells, identify the "parent cells" that produce CFTR cells, find out how long treatment should last and how often it needs to be repeated.

The first cystic fibrosis gene therapy experiments have involved lung cells because these cells are readily accessible and because lung damage is the most common, life-threatening problem in CF patients. But scientists hope that the technologies being developed for lung cells will be adapted to treat other organs affected by CF.

Genetic Research May Lead to New Drugs to Treat Cystic Fibrosis

Another research breakthrough offers a promising approach to treating cystic fibrosis. Researchers at the University of Washington's Genome Center and at PathoGenesis Corporation have completed a genetic map for the Pseudomonas aeruginosa bacterium. This bacterium is the most common cause of chronic and fatal lung infections for people with CF. Scientists hope to use their knowledge of this bacterium's genetic sequence to develop innovative drugs for treating infections caused by P. aeruginosa.

Gene Database Speeds Research

As the amount of information about CF grows, scientists have recognized the need to share their research findings. To facilitate this sharing of information, the Cystic Fibrosis Foundation funds Cystic Fibrosis Foundation Therapeutics (CFFT) located at The University of North Carolina Chapel Hill. The center is becoming a repository for data derived from gene expression studies. By pooling information, researchers hope to accelerate the process of finding a cure for CF.

Is there a test for the cystic fibrosis gene?

CF has a variety of symptoms, including very salty-tasting skin, a persistent cough and excessive appetite but poor weight gain. The "sweat test" - which measures the amount of salt in sweat - is the standard diagnostic test for those with symptoms. A high salt level indicates CF.

But one in 31 Americans - more than 10 million people - are symptom-less carriers of the defective CF gene and can pass on the defective gene to their children. To develop CF, a child must inherit a defective gene from both parents. If both parents are carriers, there is a 25 percent chance that each child they conceive will have CF, and a 50 percent chance that the child will be a carrier.

The purpose of carrier testing - a laboratory test done on a sample of blood or saliva - is to see if a couple is at risk for giving birth to a child with CF. Carrier testing is not infallible. It cannot detect all of the CF gene mutations. In rare cases, a person can have a normal test result and still be a CF carrier.

If both parents are carriers, they may want to consult with a genetic counselor for help in deciding whether to conceive or whether to have a fetus tested for CF.

Prenatal testing for CF can be done around the 11th week of pregnancy using chorionic villi sampling (CVS). This involves removing a tiny piece of the placenta. Or, the fetus can be tested with amniocentesis, around the 16th week of pregnancy. In this procedure, a needle is used to take amniotic fluid surrounding the baby for testing. Since CF cannot be treated before birth, the purpose of prenatal testing is to prepare parents to care for a baby with special health needs, or to make a decision about terminating the pregnancy.

Idiopathic pulmonary fibrosis is a chronic, progressive lung disease. This condition causes scar tissue (fibrosis) to build up in the lungs, which makes the lungs unable to transport oxygen into the bloodstream effectively. The disease usually affects people between the ages of 50 and 70. Idiopathic pulmonary fibrosis belongs to a group of conditions called interstitial lung diseases (also known as ILD), which describes lung diseases that involve inflammation or scarring in the lung.

The most common signs and symptoms of idiopathic pulmonary fibrosis are shortness of breath and a persistent dry, hacking cough. Many affected individuals also experience a loss of appetite and gradual weight loss. Some people with idiopathic pulmonary fibrosis develop widened and rounded tips of the fingers and toes (clubbing) resulting from a shortage of oxygen. These features are relatively nonspecific; not everyone with these health problems has idiopathic pulmonary fibrosis. Other respiratory diseases, some of which are less serious, can cause similar signs and symptoms.

In people with idiopathic pulmonary fibrosis, scarring of the lungs increases over time until the lungs can no longer provide enough oxygen to the body's organs and tissues. Some people with idiopathic pulmonary fibrosis develop other serious lung conditions, including lung cancer, blood clots in the lungs (pulmonary emboli), pneumonia, or high blood pressure in the blood vessels that supply the lungs (pulmonary hypertension). Most affected individuals survive 3 to 5 years after their diagnosis. However, the course of the disease is highly variable; some affected people become seriously ill within a few months, while others may live with the disease for a decade or longer.

In most cases, idiopathic pulmonary fibrosis occurs in only one person in a family. These cases are described as sporadic. However, a small percentage of people with this disease have at least one other affected family member. When idiopathic pulmonary fibrosis occurs in multiple members of the same family, it is known as familial pulmonary fibrosis.

What is pulmonary hypertension?

Pulmonary hypertension happens when the pressure in the blood vessels leading from the heart to the lungs is too high.

With pulmonary hypertension, the blood vessels to the lungs develop an increased amount of muscle in the wall of the blood vessels. The heart pumps blood from the right ventricle to the lungs to get oxygen. Because the blood does not have to travel very far, the pressure in this side of the heart and in the artery taking blood from the right ventricle to the lungs is normally low—usually much lower than systolic or diastolic blood pressure.

When the pressure in this artery gets too high, the arteries in the lungs can narrow and then the blood does not flow as well as it should, resulting in less oxygen in the blood.

What causes pulmonary hypertension?

Some common underlying causes of pulmonary hypertension include high blood pressure in the lungs’ arteries due to some types of congenital heart disease, connective tissue disease, coronary artery disease, high blood pressure, liver disease (cirrhosis), blood clots to the lungs, and chronic lung diseases like emphysema. Genetics also play a role.

Pulmonary hypertension can happen in association with many other diseases, such as lung disease and heart disease. Heart failure is common in pulmonary hypertension.

What are the risk factors for pulmonary hypertension?

• Pulmonary hypertension happens at all ages, including children, and its incidence increases with age.
• Pulmonary hypertension is more common among women, non-Hispanic black people, and people age 75 or older.

What are the signs and symptoms of pulmonary hypertension?

The symptoms of pulmonary hypertension during the initial stage of the disease are common to many other medical conditions (e.g., difficulty breathing, fatigue). This often results in a delayed diagnosis until more severe symptoms arise, such as dizziness, chest pain, ankle swelling, or feeling the heart race or pound (palpitations).

How is pulmonary hypertension treated?

There is no cure for pulmonary hypertension. However, there are many different types of treatments, including

• Inhaled medicine
• Medicine given through the veins under the skin
• Medicine to reduce swelling in the feet (diuretics)
• Oxygen therapy

How can I prevent pulmonary hypertension?

While not all pulmonary hypertension can be prevented, you can take steps to prevent it by making healthy lifestyle changes and managing high blood pressure, coronary heart disease, chronic liver disease, and chronic lung disease from tobacco use.

If you get into a medical center's transplant program, you'll be placed on the Organ Procurement and Transplantation Network's (OPTN's) national waiting list. Your transplant team will work with you to make sure you're ready for the transplant if a donor lung becomes available.

Waiting for a donor lung can be frustrating. However, you can do several things to prepare.

• Go to all of your medical appointments with the transplant team. Take all of your medicines as prescribed.
• Stay as healthy as possible. Don't smoke, and follow your doctor's advice about breathing exercises, physical activity, diet, and drinking alcohol.
• Talk regularly with your transplant team. You and your family should know what to do if a donor lung becomes available. You also should know what to expect before, during, and after the transplant.
• Be ready to go to the transplant center right away if a donor lung becomes available. Make sure the transplant center knows how to reach you at any time, day or night. Your transplant team may give you a pager so they can reach you right away. Make travel and lodging plans in advance. Have a packed suitcase ready to go.

While you wait for a lung, you may feel worried, scared, anxious, or depressed. These feelings are normal in this situation. Talk with your health care team about how you feel. They can offer tips for coping with your emotions. Family and friends also can offer support.

When a Donor Lung Becomes Available

OPTN matches donor lungs to recipients based on need. OPTN will consider how severe a person's disease is and how quickly it's worsening. OPTN also will consider whether the transplant will improve the recipient's chances of survival, and by how much.

Organs are matched for blood type and the size of the donor lung and the recipient.

If OPTN and your transplant center think they have a good match for you, the center will ask you to come in as soon as possible.

Once you arrive, your team will do tests to make sure you're healthy enough to have the surgery and that the lung is a good match. If you're healthy enough and the lung is a good match, the team will prepare you for surgery.

Just before lung transplant surgery, you will get general anesthesia (AN-es-THE-ze-ah). The term "anesthesia" refers to a loss of feeling and awareness. With general anesthesia, you will be asleep during the surgery and not feel any pain.

Once you're asleep, your doctors will make a small incision (cut) in your chest. Next, they will insert a central venous catheter into a vein. This tube allows easy access to your bloodstream. Doctors use it to deliver fluids and medicines to your body.

Your doctors also will insert a tube in your mouth and down your windpipe to help you breathe. They also will insert a tube in your nose and down to your stomach to drain contents from your stomach. A catheter will be used to keep your bladder empty.

The surgeon will make a cut in your chest to open it. He or she will then cut the main airway to your diseased lung and the blood vessels connecting your lung to your heart.

The surgeon will remove your diseased lung and place the donor organ in your chest. Then the surgeon will connect the main airway of the donor lung to your airway and its blood vessels to your heart.

Lung Transplant

If you're having a double-lung transplant, you may be connected to a heart-lung bypass machine. This machine takes over for your heart and pumps oxygen-rich blood to your body. For more information about the heart-lung bypass machine and an illustration, go to the Diseases and Conditions Index Heart Surgery article.

During a double-lung transplant, the surgeon will remove your diseased lungs, one at a time, and replace them with the donor lungs.

A single-lung transplant usually takes 4 to 8 hours. A double-lung transplant usually takes 6 to 12 hours.

Some people may need a heart–lung transplant. A heart–lung transplant is surgery in which both the heart and lung(s) are replaced with healthy organs from a deceased donor. For this surgery, you're connected to a heart-lung bypass machine.

Recovery in the Hospital

After lung transplant surgery, you'll go to the hospital's intensive care unit (ICU) for at least several days. The tubes that were inserted before surgery will remain for a few days.

The tube in your windpipe helps you breathe. Other tubes deliver medicines to, and drain fluids from, your body. You also will have sticky patches called electrodes attached to your chest to monitor your heart.

After leaving the ICU, you'll go to a hospital room. The staff will carefully oversee your recovery.

You'll be taught how to do deep breathing exercises with an incentive spirometer (spi-ROM-eh-ter). This hand-held device helps you take slow, deep breaths. You also may have lung function tests that use a regular spirometer. This device measures how much air your lungs can hold. It also measures how fast you can blow air out of your lungs after taking a deep breath.

You'll need to cough often. Coughing helps clear fluids from your lungs so they can work well. A nurse will show you how to hold a pillow tightly near your incision site while you cough to help decrease discomfort.

Your immune system will regard your new lung as a "foreign object." It will create antibodies (proteins) against the lung. This may cause your body to reject the new organ. To prevent this, your doctor will prescribe medicines to suppress your immune system.

Because these medicines can weaken your immune system, you're more likely to get an infection after the transplant. Your medical team will take steps to prevent infections while you're in the hospital.

On average, people who have a lung transplant stay in the hospital from 1 to 3 weeks. However, some people have complications and stay much longer.

Recovery After Leaving the Hospital

Before you leave the hospital, your medical team will teach you how to keep track of your overall health. You'll learn how to watch your weight and check your blood pressure, pulse, and temperature. Staff also will show you how to check your lung function.

You'll also learn the signs of the two main complications of lung transplant surgery: rejection and infection. (For more information, go to "What Are the Risks of Lung Transplant?")

For the first 3 months after surgery, you'll go to the hospital often for blood tests, chest x rays, lung function tests, and other tests. After 3 months, if you're doing well, you'll visit less often.

Making healthy lifestyle choices is very important. Not smoking, following a healthy diet, and following your doctor's advice on using alcohol will help you recover and stay as healthy as possible.

A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources include general information about healthy eating.

Your doctor may recommend pulmonary rehabilitation (PR) after your lung transplant surgery. PR is a broad program that may include exercise training, education, counseling, and more. For more information, go to the Health Topics Pulmonary Rehabilitation article.

Emotional Issues and Support

Having a lung transplant may cause fear, anxiety, and stress. While you're waiting for a lung transplant, you may worry that you won't live long enough to get a new lung. After surgery, you may feel overwhelmed, depressed, or worried about complications.

All of these feelings are normal for someone going through major surgery. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

A lung transplant can improve your quality of life and extend your lifespan. The first year after the transplant is the most critical. This is when the risk of complications is highest.

In recent years, short-term survival after lung transplant has improved. Recent data on single-lung transplants show that:

• About 78 percent of patients survive the first year
• About 63 percent of patients survive 3 years
• About 51 percent of patients survive 5 years

Survival rates for double-lung transplants are slightly better. Recent data show that the median survival for single-lung recipients is 4.6 years. The median survival for double-lung recipients is 6.6 years. Talk with your doctor about what these figures may mean for you.

Complications

The major complications of lung transplant are rejection and infection.

Rejection

Your immune system will regard your new lung as a "foreign object." It will create antibodies (proteins) against the lung. This may cause your body to reject the new organ.

To prevent this, your doctor will prescribe medicines to suppress your immune system. You’ll need to take these medicines for the rest of your life.

Rejection is most common in the first 6 months after surgery, but it can happen any time after the transplant. Rejection can happen slowly or suddenly. Your doctor will teach you how to spot possible signs and symptoms of rejection. If you know these signs and symptoms, you can seek treatment right away.

Signs and symptoms of rejection include:

• Fever and flu-like symptoms
• Chest congestion
• Coughing
• Shortness of breath
• New pain around the lung
• Generally feeling unwell

If you have any of these signs or symptoms, seek medical care. Your doctor may prescribe medicines to treat the rejection and prevent complications.

These medicines may cause side effects, such as headaches, nausea (feeling sick to your stomach), and flu-like symptoms. If you have side effects, tell your doctor. He or she may change your medicines or adjust the doses.

Infection

The medicines you take to prevent the rejection of your new lung may weaken your immune system. As a result, you're more likely to get infections.

While you're in the hospital, staff will take special steps to prevent you from getting infections. After you leave the hospital, you also can take steps to prevent infections:

• Wash your hands often.
• Take care of your teeth and gums.
• Protect your skin from scratches and sores.
• Stay away from crowds and from people who have colds and the flu.

Other Risks

Long-term use of medicines that suppress the immune system can cause diabetes, kidney damage, and osteoporosis (thinning of the bones). These medicines also can increase the risk of cancer. Talk with your doctor about the long-term risks of using these medicines.