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Lung Transplant Process at University of Colorado Hospital

Click on the headings below to learn about the different phases of the lung transplant process.

Before Your Lung Transplant Surgery

Before you receive a lung transplant, you have a series of tests to determine your current health.

After these tests are performed, you have a thorough evaluation with various members of the lung transplant medical team.

Following your tests and evaluation, your case is presented to the Lung Transplant Candidate Selection Committee. The committee is made up of transplant program doctors, surgeons, nurse coordinators, social workers, clergy and psychiatrists who determine whether a lung transplantation is a safe procedure for you. They also will discuss a plan of care for you after transplantation. It will take approximately one to two weeks to review your case.

Your transplant coordinator will inform you of the committee’s decision and plan.

Once you are accepted for transplant, your information will be entered on the active transplant waiting list and the search begins for a new lung(s) for you.

Please note that every patient on the waiting list may be randomly screened for drugs or alcohol at any time. The screening test may be done using a blood or urine sample. Anyone who has a positive test for alcohol or illegal drugs will be removed from the waiting list.

About the Wait List for a Lung Transplant

The University of Colorado Hospital Lung Transplant Program follows the United Network for Organ Sharing (UNOS) system for prioritizing lung transplant candidates. UNOS is a nationwide network supervised by the federal government to help ensure that all patients receive healthy organs as soon as they become available. All transplant centers in the United States belong to UNOS.

For this system to work, it relies on organ procurement organizations, called OPO’s. OPO’s match and distribute donated organs, 24 hours a day, 365 days a year.

The OPO in our region is Donor Alliance (DA). DA is responsible for the coordination, retrieval and distribution of organs in Colorado and Wyoming.

The process of matching donor organs to patients awaiting transplant is based on many criteria to make sure patients are stable and prepared, including:

  • Medical urgency of the transplant candidate
  • Time spent on the waiting list
  • Biologic compatibility (organ size, blood type, etc.)
  • The candidate’s ability to be transplanted immediately

If all candidates are of similar degrees of illness, then it is offered to the person with the longest waiting time.

Donated organs are distributed locally first. If no suitable match exists in the local area, the organ is offered regionally and then nationally.

During the waiting period, you will begin a pulmonary rehabilitation program. A rehabilitation specialist and pulmonologist will design an exercise program to improve your muscle strength and endurance. This will help you to have a more successful recovery after your transplant. Your pulmonologist will keep the transplant surgeon and coordinator informed about changes in your condition.

If you live far away from University of Colorado Hospital, your care may be managed by your primary care doctor. It is important that your primary doctor keep in close contact with the transplant team regarding your medical condition and care.

Your Lung Transplant Surgery

After you have received a call to come to the hospital for your transplant surgery, do not drink or eat anything because your stomach should be empty for surgery. When you arrive you are admitted to the transplant unit. This is where preparation for surgery begins.

Upon arrival to the transplant center you will:

  • Meet with your doctors and surgeons
  • Sign one or more consent forms
  • Have a few routine tests such as chest X-ray, EKG and blood draw
  • Be given medications important for the success of your transplant

Your surgery will not begin until the donor lung:

  • Arrives at the Hospital
  • Is examined by the transplant surgeon
  • Is considered to be acceptable

Once the decision to proceed with the surgery has been made, you will be given an anesthetic to put you to sleep for the surgery.

Lung transplant surgery can be divided into four stages:

  • Incision
  • Removal of the diseased lung(s)
  • Replacement with the new lung(s)
  • Closing the incision

Single Lung Transplant

An incision or cut is made on the side of your chest that will receive the transplant. Your diseased lung is removed and replaced with the new organ. During the transplant you will breathe with only one lung.

If you cannot breathe well enough, you may be placed on a cardiopulmonary bypass machine. The bypass machine will take over the work of your lung by putting oxygen into your blood and removing carbon dioxide from your blood.

After the new lung is in place, chest tubes will be placed to remove any extra fluid from the area and your incision is closed. A single lung transplant lasts approximately four hours.

Bilateral (double) Lung Transplant

An incision or cut is made across your entire chest at the base of your breasts. Each lung is replaced separately. The most diseased lung is removed first and replaced with the new organ. During the first transplant you will breathe with your other lung.

If you cannot breathe well enough, you may be placed on a cardiopulmonary bypass machine. The bypass machine will take over the work of your lung by putting oxygen into your blood and removing carbon dioxide from your blood.

After first new lung is in place, the same process is used to replace your other disease lung. Cardiopulmonary bypass may be used during the second phase of the transplant to reduce stress on your heart and the new lung. Chest tubes will be placed to remove any extra fluid from the area and your incision is closed. A bilateral lung transplant lasts approximately six to eight hours.

After Your Lung Transplant Procedure

After surgery you will go to a private room in the Intensive Care Unit (ICU) for recovery. You will have a breathing tube that is hooked up to a respirator to help you breathe. You will remain on the respirator from 24 to 48 hours. You will be given medication to keep you sleepy and unable to move.

Depending on your condition your medication will be decreased and you will gradually be able to breathe on your own without the respirator. Once you can breathe on your own the breathing tube will be removed.

A respiratory therapist will help you do breathing exercises and coughing to get you stronger and prevent pneumonia. Your stay in ICU will usually last two to three days, but may be longer depending on your condition.

From ICU you will go to a room in a specialized transplant unit. Here you will begin a closely monitored recovery process.

You will work with the pulmonary rehabilitation specialist and physical therapist to improve your strength and conditioning.

You will need Glanciclovir, an IV medication to prevent viral infections, for one month after surgery. Since you will be at home for a portion of this time, a tube called a Peripherally Inserted Central Catheter (PICC line) will be placed below your elbow so that you can administer the medication at home.

You and your family will participate in various education sessions about:

  • The PICC line
  • Medication
  • Diet
  • Exercise program
  • Follow-up care

Your stay here usually lasts three to 10 days depending on your condition.

Life After Your Lung Transplant

Post-surgery review

You will need close monitoring for the first several months after you leave the hospital.

Your PICC line will remain in place until you have completed a one month course of Glanciclovir. A nurse will visit your home to assist you with flushing and changing the dressing of your PICC line.

Each day you will need to record your:

  • Temperature
  • Weight
  • Blood pressure
  • Oxygen saturation

You will be given the proper equipment and teaching for monitoring these items at home.

Initially, you will need to return for appointments and procedures twice a week for the first few weeks and then weekly for the next few months.

You also will have a series of bronchoscopy procedures for the first year after transplant.

In a bronchoscopy, a specialist removes small pieces of your lung, which are then examined by a pathologist for signs of rejection. The biopsies are not painful and only require numbing medication.

Long-term medical follow-up is extremely important so that any problems can be detected early.

The Most Common Problems After a Lung Transplant

The two most common problems after a lung transplant are rejection and infection.

You will be prescribed important medications that will help prevent these problems. You will also be asked to avoid large crowds for the first four to six weeks, always avoid people with infectious diseases and wear a mask when in crowds or entering the hospital.

These steps, along with regular blood tests, biopsies and examinations, will help doctors detect these problems early so your transplant team can correct or treat them. You will receive a complete list of symptoms that may indicate a complication. Any signs should be reported to your transplant team immediately.

You will not be allowed to drive for at least six weeks. You will need to discuss returning to work or any travel plans with your pulmonologist. It is suggested you wait six months as most complications occur within the first few months after surgery.

If you are from out of town, we request that you stay in the Denver area for approximately three months after your surgery. After that time, your transplant coordinator will arrange for your long-term follow-up care to be managed by your local doctor and lab facility.

The Importance of Exercise After Your Lung Transplant

Exercise for transplant patients has been shown to:

  • Increase endurance
  • Increase muscle strength
  • Reduce the need for anti-hypertension medication

The pulmonary rehabilitation program will assist you in setting up an exercise program that is right for you. Initially, your exercise program will include walking as much as possible several times a day. Other activities can be added to your exercise program gradually as your doctor allows.

For the first six to eight weeks after surgery we ask that you:

  • Do not lift anything heavier than 10 pounds
  • Do not push or pull objects heavier than 10 pounds
  • Do not attempt sit-ups, push-ups or pull-ups
  • Discontinue any activity that causes pain or pulling across the chest. THIS INCLUDES DRIVING.

Your Diet After Your Lung Transplant

Proper nutrition is critical for post-lung transplant patients. Certain medications you may take will affect the way your body processes food. You will receive medication guidelines related to your diet.

Your dietitian at the hospital will help you create meal plans that are both nutritious and low in calories. Your diet is important in the total rehabilitation process and for maintaining a good nutritional status throughout your life with your new lung(s).

General Health Guidelines to Follow Post-Transplant

You will be given a variety of specific guidelines regarding your general health and personal care after transplant. Some of the most important guidelines include:

  • You must never smoke or be in a smoking environment. If family members smoke, they must smoke outside of your home. Smoking causes damage to your lungs and can cause a life-threatening infection.
  • Some of your medications may cause a variety of skin problems including acne, irritation, easy bruising, dry skin and sun sensitivity. Please follow the recommended care instructions and report any change in severity to your transplant team.
  • Drinking alcohol is not recommended. The combination of your medication and alcohol may damage your liver.
  • You must report all illnesses to the transplant team for proper instructions. This includes cold, flu, cold sores, headaches or sores that do not heal.
  • You must contact the transplant team before receiving any immunizations. You MUST NEVER receive immunizations for Smallpox, Measles, Rubella, or any vaccine containing a live virus.

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