Lung Transplant is a surgical procedure performed to replace an ailing lung with a healthy lung from a living or deceased donor. Depending on the clinical condition, a lung transplant may involve replacing one or both of the lungs. In some cases, the lungs maybe transplanted with a donor heart.
Fortis Hospitals Mumbai, Lung Transplant Department offers comprehensive care for patients of all age-groups (including paediatric patients) requiring lung transplantation. Centre delivers modern diagnostic procedures to evaluate and treat patients with serious lung ailments. Our surgeons have extensive experience in performing advanced lung transplantation techniques (single lung, double lung transplants) including surgical interventions for patients with complex conditions needing multiorgan transplants (heart-lung transplantation).
Our transplant team utilises a collaborative approach working across experts in departments such as pulmonology, cardiovascular surgery, thoracic surgery, intensive care and oncology, to bring customised care for patients. At our centre, patient is actively involved in understanding the risks and benefits of the care plan, to enable a smooth transition post-transplant, to lead a longer, better quality of life. Pivotal to our lung transplant program is the psychosocial and mental wellbeing support, health education and advanced care including rehabilitation services, accessible to the patient and the family throughout the clinical journey. We stand as a testimony to successful lung transplants with best surgical outcomes, at par with international standards.
Our multi-disciplinary lung transplant team ensuring personalised care:
Lung Transplant Surgeons
Pulmonologists
Onco-Pulmonologists
Dermatologists
Anaesthetists
Well-trained transplant nurses, transplant coordinators, social workers, physiotherapists, psychologists and clinical nutritionists
The team is well supported by intensive care specialists, infectious diseases specialists, radiologists and clinical pharmacologists.
A lung transplant is advised for people who have exhausted all other medical treatments without sufficient improvement. Damaged lungs make it difficult for the body to get the oxygen it needs and a variety of diseases can hinder the lung’s ability to function effectively. Some of the most common causes for a lung transplant include:
Chronic obstructive pulmonary disease (COPD), including emphysema
Cystic fibrosis
Pulmonary fibrosis (scarring of the lungs)
Pulmonary hypertension (high blood pressure in the lungs)
Other conditions such as bronchiectasis, histiocytosis, sarcoidosis and certain hereditary conditions affecting the lungs
Lung damage can usually be treated with medications or special breathing devices but when these methods are not helpful, doctors may advise single or double lung transplant. In some cases, people with serious heart and lung ailments may need a combined heart-lung transplant.
However, certain conditions may make a person not eligible for a lung transplant. These include:
Active infection
Current/recent cancer
Serious illness such as kidney, liver or heart diseases
Unwilling or unable to make lifestyle changes necessary for getting a lung transplant, such as not drinking alcohol or not smoking
Complications arising with lung transplant can be serious. The risks associated with a lung transplant include:
Bleeding
Blockage of the airways
Blockage of blood vessels to the new lung/s
Infection
Pulmonary oedema (fluid in the lung)
Failure or rejection of the lung/s
Major risks of the procedure are rejection and infection. Rejection of the donor organ is a normal reaction of the body’s immune system to attack a foreign object or tissue. Medications can suppress the rejection; anti-rejection medications or immunosuppressants cause variety of side-effects including:
Weight gain
Facial hair
Stomach problems
Some anti-rejection medications side-effects may develop new conditions or aggravate existing conditions including:
Cancer
Diabetes
High blood pressure
Kidney damage
Osteoporosis (bone thinning)
The anti-rejection medications work to suppress the body’s, making it prone to infection. Doctors may recommend the following to help prevent infection, especially to the lungs:
Washing hands regularly
Brushing teeth and gums regularly
Protection of skin from scratches/sores
Avoiding crowds and people who are unwell
Receiving appropriate vaccinations
The evaluation process includes:
A thorough physical exam
Blood tests - to assess priority on the donor list and find a good donor match.
Diagnostic tests - X-ray, CT/MRI scans, pulmonary function test, lung biopsy and dental exams. Women may need to undergo a pap test, gynaecological exam and a mammogram.
Psychological and social evaluation - including stress, financial concerns, support from family and friends post the surgery.
Once the tests are completed, the transplant team assesses the patient’s clinical condition to undergo the lung transplant and decides on the best treatment plan.
The types of lung transplant procedures include:
Single lung - transplant of one lung
Double lung - transplant of both lungs.
Bilateral sequential - transplant of both lungs, done one at a time. It’s also called bilateral single.
Heart-lung transplant - transplant of both lungs and the heart taken from a single donor.
Most often the lungs that are transplanted come from deceased organ donors, this kind of transplant is called a cadaveric transplant. Healthy, non-smoking adults who are a good match may be able to donate part of one of their lungs, this part of the lung is called a lobe, this kind of transplant is called a living transplant. People who donate their lobe can continue to live healthy lives with the remaining lungs. In case a compatible living donor is not available, the patient will be placed on a waiting list for a deceased donor lung/s. The number of people waiting for a transplant is more than the available deceased donor lungs hence the waiting time maybe long.
During the long wait for a donated lung or a scheduled transplant surgery, it’s important to stay healthy. Leading an active and healthy lifestyle will aid in speedy recovery from surgery. Points to keep in mind:
Stop smoking
Continue with medications, as prescribed
Follow diet and exercise guidelines
Involving self in healthy activities, including relaxing and spending time with family and friends
Keep in regular touch with the care team including information on any significant changes in health.
Finding a donor match - The transplant team considers several factors to evaluate if a donor lung will be a good match including blood type, size of organ compared to chest cavity and donor’s overall health.
The procedure is conducted with general anaesthesia, so the patient is asleep and there will be no pain. A tube is guided through the mouth and into the patient’s windpipe to enable breathing. The surgeon makes a cut in the chest to remove the diseased lung. The main airway to that lung and the blood vessels between that lung and the heart will then be connected to the donor lung. For some lung transplants, patient may be connected to a heart-lung bypass machine, which circulates blood and oxygen during the procedure.
Post-surgery, patient will be in the hospital's intensive care unit (ICU) for several days.
Patient is connected to a mechanical ventilator to help in breathing and tubes in the chest to drain fluids from the area around the lungs and heart.
A tube in a vein will deliver medications to control pain and prevent rejection of the new lung.
Once the doctor feels there’s improvement, patient will be taken off the ventilator and moved out of the ICU to a ward/recovery area for few more weeks of hospital stay. The amount of time in the ICU and in the hospital can vary from patient to patient.
Frequent check-ups - On leaving the hospital, frequent monitoring will be done by the transplant team to assess complications with tests including:
Chest X-rays
Electrocardiogram (ECG)
Lung function tests
Lung biopsy
Life-long medications - a number of medications such as immunosuppressants (anti-rejection medications) and drugs to reduce the risk of other complications, such as infection post the transplant, will be prescribed.
Living a healthy lifestyle - patient will be advised to not use tobacco products and limit alcohol. Exercise and physical activity should be a regular part of life to continue improving overall physical and mental health. Exercise is a crucial part of rehabilitation after the lung transplant and will start within days of the surgery. Following a nutritious diet will further help in staying healthy.
Coping - seeking the support of friends and family members can help cope during this time. The transplant team may also assist in finding resources such as a support group for transplant recipients including pulmonary rehabilitation services to help in improving breathing and daily functioning post the transplant.
