Lung Transplant

The lungs are essential in transporting oxygen to the rest of the body. When lungs cease to function normally, whether from damage or disease, a lung transplant – a surgical procedure to replace one or both diseased lungs with a healthy lung(s), usually from a deceased donor – may be necessary. In some situations, the lungs may be transplanted along with a donor heart.

The Memorial Hermann Lung Transplant program partners with the Center for Advanced Heart Failure at the Larry D. Johnson Heart & Vascular Institute at Memorial Hermann-Texas Medical Center, a recognized national leader in the treatment of advanced cardiothoracic disease. Affiliated physicians, with a long history of clinical excellence, are supported by an exceptional multidisciplinary team of dedicated health care professionals. All services are provided in a state-of-the-art facility shared with McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

The multidisciplinary lung transplant team at the Transplant Center is led by affiliated pulmonary and critical care specialist Rahat Hussain, MD and affiliated cardiothoracic and vascular surgeon Manish Patel, MD. Dr. Hussain and Dr. Patel are respectively medical and surgical directors of the Lung Transplant program at Memorial Hermann-Texas Medical Center and associate professors at McGovern Medical School at UTHealth. The team is comprised of transplant surgeons, transplant pulmonologists, transplant cardiologists, transplant nurses, transplant anesthesiologists, transplant coordinators, financial counselors, social workers and dietitians.

Life-saving transplantation is made possible through the generous “gifts of life” by donors. While living, these individuals registered to become donors (upon their death), either when signing up for or renewing their driver’s licenses or through the DonateLifeTexas.org registry. If a deceased patient has not registered but is a candidate for donation, his or her next-of-kin can provide consent for donation on his or her behalf. Currently, about half of Texans are registered donors, and there are over 100,000 individuals awaiting organ transplants in the U.S.

Upon a donor’s death, the donor’s organs and/or tissues are recovered by an organ procurement organization (OPO). The OPO serving the Greater Houston area is LifeGift. To learn more about the organ donation process (for donation from deceased donors), please visit the LifeGift website.

Lung Transplant Evaluation

The evaluation process for a lung transplant is comprehensive. At the first visit the patient will be evaluated by one of the transplant pulmonologists who will also review past and current medical records along with psychosocial information. The pulmonologist will determine if the patient meets the criteria for lung transplant. The risks and benefits of getting a lung transplantation will also be explained to the patient and caregivers. Once it is determined the patient is a good candidate for the transplant he/she will undergo a thorough medical, psychological and social evaluation. Once the evaluation is completed, the multidisciplinary team (patient selection committee) will determine if a lung transplant is the best course of treatment.

Numerous tests will be performed during the evaluation including pulmonary function testing, cardiac stress test, cardiac catheterization, CT scans and a chest X-ray.

Who Is a Good Candidate for a Lung Transplant?

Most patients with severe end-stage lung disease and a life expectancy projected to be less than 2 years can be considered for a lung transplant. In most cases, a successful lung transplant can provide years of quality life and help make an individual’s breathing easier. A lung transplant is performed only after all other treatments for lung failure have been unsuccessful.

These are guidelines for referral, relating to the most common lung diseases that may benefit from a lung transplant. Patients are usually referred by their pulmonologist but can also self-refer:

• Idiopathic Pulmonary Fibrosis (IPF)/Interstitial Lung Disease (ILD) - A patient should be referred as soon as he or she is diagnosed with pulmonary fibrosis. This is a rapidly progressive disease and if a patient waits too long, there might not be enough time to complete an evaluation.
• Emphysema or Chronic Obstructive Pulmonary Disease (COPD) - The disease is progressing, despite maximal treatment, including medication, pulmonary rehabilitation, and oxygen therapy.
• Pulmonary Hypertension - Advanced physical limitations despite being on maximal medical therapy.
• Sarcoidosis - Need for oxygen at rest and progressive decrease in lung function test.
• Cystic Fibrosis and Bronchiectasis - Clinical decline characterized by increasing frequency of exacerbations associated with any of the following: an episode of acute respiratory failure requiring non-invasive ventilation, increasing antibiotic resistance and poor clinical recovery from exacerbations, worsening nutritional status despite supplementation, pneumothorax and life-threatening hemoptysis despite bronchial embolization.

Candidates are placed on The United Network for Organ Sharing (UNOS) list while awaiting transplant. Most patients will wait at home. During this time, the transplant team monitors the patient to ensure that his or her condition remains stable. Once a donor lung is identified and a thorough evaluation is performed, the patient will be called to the hospital to be admitted and prepared for the surgery.

Lung transplantation is a major thoracic surgical procedure and can be accompanied by serious risks. Short-term risks may include:

• Arrhythmia
• Bleeding
• Donor organ dysfunction
• Hyperacute or acute rejection
• Infection
• Renal failure

Long-term risks may include:

• Cancer
• Chronic rejection
• Peripheral neuropathy
• Hypertension (high blood pressure)
• Infection

Specific risks and potential benefits of a lung transplant vary for each patient. Memorial Hermann-affiliated physicians will discuss the risks and benefits in detail with each patient and make every attempt to provide a successful outcome while minimizing the risks associated with the procedures.

After the Surgery

Recovery time after a lung transplant varies for each patient. Patients may stay in the hospital from two to three weeks, or longer. Some patients spend time in the intensive care unit (ICU) after surgery. The team continues to focus on optimum patient care to provide long-term success.

The recovery period usually lasts about three to six months and includes frequent physician visits and regular tests, such as blood tests and bronchoscopies and participation to a pulmonary rehabilitation program.

Prognosis

For many patients, a lung transplant is a lifesaving procedure, opening the door to an improved quality of life and extended lifespan.

The survival rate for lung transplant patients has improved in recent years. According to the International Society of Heart and Lung Transplantation (IHHLT) the one-year survival rate of lung transplant is around 80%. The five-year survival rate is more than 50%. Those numbers were much lower 20 years ago.

After recovery, most patients do not have limitations on their physical activity and are able to enjoy a good quality of life. However, fighting rejection is an ongoing process, and there may be other complications needing treatment.

Transplantation can sometimes seem overwhelming for patients. The Transplant Center offers a transplant support group, run by our transplant social workers. The group meets monthly and includes patients who are waiting for a transplant as well as those who have already received a transplant. Adult family members, friends and caregivers are welcome and encouraged to come with the patient.

To learn more about our transplant support group, or the Lung Transplant program, call (713) 704-4300.