Lung Transplant



For patients with advanced and life-threatening lung disease who no longer benefit from other treatments, lung transplantation remains an effective option. About 1,000 patients receive a lung transplant in the U.S. every year. Lung transplantation can dramatically improve the quality of life for patients who have severe, nonmalignant pulmonary disease and no alternative treatment options.

But getting a new lung (or two new lungs) is a complex process with risks. Patients need to understand the whole process—not just the surgery—before making this major commitment. In particular, they need to learn about all the planning, testing, and waiting before the surgery and the lifetime of special care required afterwards. Patients also need to be confident that their transplant team is experienced in all the latest techniques and long-term care programs needed for the best possible results.

This section contains basic information about lung transplantation at Temple. Talk to a lung specialist at the Temple Lung Transplant Program to find out more about the specific risks and benefits of lung transplantation for someone in your situation.  

To schedule an appointment with a Temple Lung Center physician, click here or call 1-800-TEMPLE-MED (1-800-836-7536).

Why Temple?

Established in 1994, the Lung Transplant Program at Temple is one of the oldest and most experienced centers in the region. The Temple team has performed over 200 lung or heart/lung procedures and is certified by UNOS (United Network for Organ Sharing) for lung transplantation and is also Joint Commission-certified for lung volume reduction surgery (LVRS). According to recent data, the Temple Lung Transplant program has the highest one-year rate of survival among any adult lung transplant program in Pennsylvania (90.91%) and a rate of survival well over the national average, all while treating patients with a higher level of risk1. Over the past two decades, the Lung Center has expanded to meet the growing regional need for transplantation options for patients with COPD, pulmonary fibrosis, or other severe lung ailments.

Today, the program consists of a dedicated team of surgeons, clinicians, immunologists, psychologists, nurse specialists, technicians, counselors, nutritionists, and financial coordinators. It is led by the internationally renowned transplant surgeon Yoshiya Toyoda, MD, PhD.

Temple's thoracic surgery team includes: Drs. Yoshiya Toyoda, T. Sloane Guy, and Larry Kaiser. These surgeons are board-certified in both general surgery and cardiothoracic surgery and are experienced in lung transplantation techniques. Dr. Toyoda pioneered the antero-axillary approach in lung transplantation, a minimally invasive form of surgery that avoids many complications of the standard procedure.

Temple surgeons collaborate with Temple pulmonologists to evaluate patients for potential procedures (transplantation or other) and to coordinate pre- and post-surgical tests and procedures. They are also engaged in research aimed at improving lung transplantation outcomes, including studies on preservation of donated organs, immunosuppressive medications, antibiotic use, echocardiographic evaluation of patients, alternative therapies for wait-listed patients, and minimally invasive therapies.

While there is no question that transplantation can be a life-saving step for a patient with advanced lung disease, not all patients are ideal candidates for surgery. For those patients who are unsuitable for, or do not want, transplantation, the Temple team excels in offering novel therapies or aggressive applications of traditional therapy.

Temple clinicians consider all treatment options, including medical options, as alternatives for every new patient being evaluated for transplantation. These options are changing fast and Temple pulmonologists and critical care specialists can evaluate the pros and cons of the full range of novel drug therapies, biotech agents, devices, special procedures, and surgeries for each patient depending on their unique clinical situation and their preferences. Direct Temple involvement in research ensures that patients referred for surgery evaluation are seriously considered for alternative and novel therapies (e.g., alternatives to LVRS such as endobronchial valves and biologic LVR; new methods of mechanical ventilation; anti-fibrotic agents in pulmonary fibrosis). 

Patients with advanced lung disease need every edge they can get. The Temple Lung Center provides this extra edge in the carefully customized medical and surgical care plans developed for every patient. Transplantation is one option. Temple is ready to help patients and their families explore all options.

To schedule an appointment with a Temple Lung Center physician, click here or call 1-800-TEMPLE-MED (1-800-836-7536).

What is Lung Transplantation?

In lung transplantation, a surgeon replaces a diseased lung with a healthy lung, usually from a deceased donor. One or both lungs may be replaced. In some cases, a heart transplant is performed at the same time. New lungs help the body get the oxygen needed to survive. Most patients need to take powerful immunosuppressant drugs for the rest of their lives to reduce the risk of rejection.

The main steps in the lung transplant process are:

  1. Finding out if you are sick enough to need a new lung… and healthy enough to receive a new lung. To determine a patient's likelihood for a successful transplant, the patient is carefully evaluated by a team of specially trained Temple staff. This team, which includes pulmonologists, surgeons, immunologists, nurses and social workers, will take into account the patient's physical and psychological health and suitability for major surgery. A pulmonologist will talk with you, evaluate your medical records, perform tests (e.g., heart and lung scans, pulmonary function tests, CT scans etc.), and rule out other possible treatments to determine if you are a candidate for lung transplantation. In some cases, adjusting medications or a different procedure can improve symptoms and avoid the need for transplantation.

  2. Preparing for the operation and waiting for a donor match.  In many cases, patients need to reduce certain risks or undergo further tests or procedures before qualifying for the surgery. Once eligible, patients are added to the national waiting list for a donor lung. The list is administered by the United Network for Organ Sharing (UNOS). As organs become available, UNOS contacts the most appropriate match based on factors including: blood type, size of organ, distance between donor organ and patient, and the patient's overall health and likelihood of success. The improved wait list procedure, started in 2005, has reduced the average wait time from 2 years in 2004 to about 3 or 4 months today. [Yusen. Am J Transplant 2010;10:1047-1068]  However, patients should realize that their wait can last months or years.

  3. Receiving the lung transplant.  When a lung becomes available, the patient is contacted and must report to the hospital immediately so that the transplant team can perform a final evaluation prior to surgery. This is to ensure that the recipient is still in appropriate condition for transplantation. Once approved, the patient will then be prepared for surgery. Prior to surgery, the donated organ must be examined carefully by the retrieving surgeon to determine whether it is still functioning properly. This last-minute check is important and improves the likelihood of a successful transplant. In some cases, an organ will fail inspection and the transplant will be cancelled. Should the organ pass inspection, the transplant team will begin surgery. Depending upon the complexity of the case, surgery can last from 4 to 12 hours. The operation usually involves a full sternotomy (splitting of the breastbone) although Temple surgeons have developed a new minimally invasive technique that is appropriate for some patients. After surgery, patients usually stay in the hospital (first the ICU and then a special pulmonary care unit) for about 2 to 3 weeks. Some stays extend for even longer.

  4. Going home, getting better, staying healthy.  Soon after surgery a transplant recipient will begin education and physical rehabilitation. This continues after the patient leaves the hospital. Transplant patients require approximately 6 to 8 weeks of recovery time. Recovery and rehabilitation includes: physical activity, medications (e.g. anti-rejection drugs; antibiotics as needed; and drugs for blood pressure, diabetes, and cholesterol), home testing/monitoring, and follow-up appointments for chest x-rays and screening bronchoscopies at 1, 3, 6 and 12 months after transplantation. (Bronchoscopy with biopsy is an exam and sampling of the lung through a small scope inserted through the nose to test for possible signs of rejection or infection.) The Temple transplant team also helps the patient start and stick to a long-term plan of exercise, diet, and mental health to ensure the best possible outcome.

Who Should Have Lung Transplantation?

Lung transplants are a last-resort treatment for irreversible lung failure brought on by disease. Lung failure occurs when the lungs are damaged and unable to transfer oxygen and carbon dioxide to and away from cells. Only patients who have severely damaged lungs that cannot be helped by other standard therapies are eligible for transplantation. It is always better to try all the available treatments with your own lungs before considering a transplant.

If no other treatments are possible, and if the patient does not have certain risk factors (e.g.; body weight too high or low; serious heart, liver, or kidney disease; current smoker; inability to follow a long-term health plan), then they may be a candidate for lung transplantation. Testing as described in the previous section is still required.

The conditions that most commonly lead to end-stage lung disease requiring transplantation include:

  • Chronic obstructive pulmonary disease (COPD) including emphysema
  • Pulmonary fibrosis
  • Pulmonary hypertension
  • Cystic fibrosis
  • Sarcoidosis

Lung transplantation is not recommended as a treatment for lung cancer.

Only patients willing to commit to a life-long partnership with the transplant team should consider moving ahead with plans for a lung transplant.

What are the risks and benefits of lung transplantation?


The main potential risks of lung transplantation include:

  • The possibility that no matched organ will ever become available
  • Surgical risks related to a long operation (e.g., blood loss, infection)
  • Infections due to the immunosuppressant (anti-rejection) drugs
  • Side effects of anti-rejection drugs (e.g., in addition to increasing infection risk, they may also harm the kidneys or cause diabetes, hypertension, osteoporosis, or cancer)
  • Rejection of the transplanted organ leading to bronchiolitis obliterans syndrome or primary graft failure and the possible need for retransplantation

The potential benefits of lung transplantation include:

  • A longer life: Survival rates for lung transplant recipients depend upon a variety of factors. Overall, survival rates in the U.S. after lung transplantation are 83% at 1 year, 54% at 5 years, and 29% at 10 years. [Yusen. Am J Transplant 2010;10:1047-1068] Ongoing research offers hope for new developments and new medications that will improve long-term survival rates.
  • A better quality of life: For many patients, lung transplant hits the restart button on life, allowing them to resume many of the daily activities they enjoyed prior to their illness. If patients stick to the rehabilitation program after surgery (e.g., physical activity, breathing exercises and nutritional changes), they can expect benefits such as: easier breathing; fewer trips to the emergency room; less need for oxygen supplementation; greater ability to exercise and enjoy sports, family outings, and everyday activities.

Temple cardiothoracic surgeons and pulmonary specialists can explain the exact eligibility requirements, risks, and potential benefits of lung transplantation for someone in your situation.

To schedule an appointment with a Temple Lung Center physician, click here or call 1-800-TEMPLE-MED (1-800-836-7536).

Sources:
1. Scientific Registry of Transplant Recipients, For Patients Transplanted between 07/01/2010 and 12/31/2012. SRTR release January 2014.