What is a lung transplant?

A lung transplant is surgery done to remove a diseased lung and replace it with a healthy lung from another person. The surgery may be done for one lung or for both. 肺移植几乎适用于所有年龄段的人 从新生儿到65岁的成年人，有时甚至更晚.

Types of lung transplant procedures include:

• Single lung. This is the transplant of one lung.

• Double lung. This is the transplant of both lungs.

Why might I need a lung transplant?

以下人士可建议进行肺移植:

• 有严重的肺部问题，不能用其他药物改善 treatment, and

• 如果不做移植，预期寿命能达到12到24个月吗

在下列情况下可能需要进行肺移植:

• Severe cystic fibrosis (CF). 这是一种遗传性疾病，会导致腺体出现问题 that make sweat and mucus. It is ongoing, gets worse over time, and is usually fatal.

• Bronchopulmonary dysplasia or chronic obstructive pulmonary disease (COPD). These are lung diseases that can interfere with normal breathing.

• Pulmonary hypertension. 这是肺部动脉的血压升高.

• Heart disease. 影响肺部的心脏病或心脏缺陷可能需要一个 heart-lung transplant.

• Pulmonary fibrosis. This is scarring of the lungs.

• Other diseases. 其他可能导致严重肺损伤的疾病包括 sarcoidosis, histiocytosis, and lymphangioleiomyomatosis. Also, certain hereditary conditions can affect the lungs.

并非所有患有这些疾病的人都需要进行肺移植. A lung 移植不建议作为肺癌的治疗方法. Your healthcare 医生可能有其他原因建议进行肺移植.

What are the risks of a lung transplant?

All procedures have some risks. The risks of this procedure may include:

• Bleeding

• Infection

• 通往新肺的血管阻塞

• Blockage of the airways

• Severe pulmonary edema (fluid in the lung)

• Blood clots

• Rejection of the new lung(s)

Rejection is major risk of transplant. This is a normal body reaction to a foreign object or tissue. When an organ is transplanted into a person's body, their immune system sees it as a threat and attacks the organ. To allow the transplanted organ to survive in a new body, medicines are used 骗过免疫系统不去攻击移植的器官. The medicines 用于预防或治疗排斥反应有很多副作用. The exact side effects will depend on the specific medicines that are taken.

在某些情况下，一个人不应该进行肺移植. Reasons for this can include:

• 无法治疗的当前或复发性感染

• 已经扩散到身体其他部位的癌症(转移) cancer)

• Severe heart problems

• 使人无法忍受手术的健康问题

• Serious health conditions other than lung disease that won’t get better after transplant

• Not being willing or able to stick to all treatment requirements for getting a lung transplant

Your risks may vary depending on your general health and other factors. Ask 您的医疗保健提供者哪些风险最适合您. Talk with him or her about any concerns you have.

How do I get ready for a lung transplant?

To get a lung from an organ donor who has died, you will first be evaluated by a transplant team. The team may include:

• A transplant surgeon

• A healthcare provider specializing in the treatment of the lungs (transplant pulmonologist),

• One or more transplant nurses

• A social worker

• A psychiatrist or psychologist

• A dietitian

• A chaplain

• An anesthesiologist

The transplant evaluation process includes:

• Psychological and social evaluation. This includes assessing your stress, financial issues, and support by family and other loved ones. These issues can have a major affect the outcome of a transplant.

• Blood tests. 需要验血来帮助找到合适的供体. This helps 提高供体器官不被排斥的几率.

• Diagnostic tests. 检查你的肺部和整体健康状况. 这些检查包括x光、超声、CT扫描、肺检查 function tests, lung biopsy, and dental exams. Women may also get a 巴氏试验，妇科检查，还有乳房x光检查.

• Stopping smoking. 吸烟的肺移植受者必须戒烟. They must be nicotine-free for several months before being put on the transplant list.

• Other preparations. Several immunizations will be given. These are to lessen the chance 可能会影响移植肺的感染.

The transplant team will consider all information from interviews, your medical history, physical exam, and diagnostic tests in deciding your eligibility for a lung transplant.

Once you have been accepted as a transplant candidate, you will be placed 在器官共享联合网络(UNOS)的等待名单上.) Waiting times vary greatly. 这取决于你需要什么器官，你的年龄，你的 blood type, and the reason for your transplant. People who are unable to 等待可以考虑活体供体的肺移植.

When a donor organ is available from a deceased person, you will be notified and told to come to the hospital right away so you can be prepared for the transplant. 如果你要从活体捐献者那里得到一个肺 transplant can be done at a planned time. The potential donor(s) must have a compatible blood type and be in good health. Psychological tests will be 这样做是为了确保捐赠者对这个决定没有意见.

Before the transplant:

• Your transplant team will explain the procedure to you and give you 有机会问关于手术的任何问题.

• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is not clear.

• For a cadaver organ transplant, don’t eat or drink as soon as you are told that a lung has become available.

• For a planned living transplant, you should not eat or drink for 8 手术前几小时，通常是午夜之后.

• You may be given a sedative before the procedure to help you relax.

Your healthcare providers may give you other specific instructions to get ready.

What happens during a lung transplant?

Lung transplant requires a stay in a hospital. The way the procedure is done may vary. 这取决于你的情况和你的医疗保健提供者 methods. 在大多数情况下，程序将遵循以下过程:

1. You will be asked to remove your clothes and given a hospital gown to wear. 你还会被要求摘掉首饰或其他物品.

2. A plastic bracelet with your name and an identification number will be put on your wrist. You may get a second bracelet if you have allergies.

3. 静脉注射(IV)线将放在你的手臂或手上.

4. Thin, flexible tubes (catheters) will be put in your neck, wrist, 在锁骨下(锁骨下)或腹股沟下. These are used to monitor your heart and blood pressure, and to take blood samples.

5. You will lie down on an operating table. For a single lung transplant, you will lie on your side. For a bilateral sequential 肺移植后，你要仰卧，双臂高举 your head.

6. You will be given general anesthesia. This is medicine that 防止疼痛，让你在手术过程中睡觉.

7. A breathing tube will be put into your throat and hooked up to a breathing machine (ventilator). Your heart rate, blood pressure, 在手术过程中会观察呼吸.

8. A catheter will be put into your bladder to drain urine during the surgery.

9. Hair at the surgical site may be trimmed. The skin will be cleaned with an antiseptic solution.

10. 外科医生将在你的胸部开个切口. For a single 肺移植时，会在胸部一侧做切口 where the lung will be replaced. For a bilateral sequential transplant, the incision will be made horizontally across the chest below the breasts.

11. Depending on your lung condition and the type of transplant being 做完之后，你可能要上体外循环机了 (heart-lung machine). This machine sends blood and oxygen to your body during the procedure.

12. The diseased lung(s) will be removed and replaced with the donor lung(s). 新肺的血管和气道将被连接起来. For a bilateral sequential transplant, the lungs will be attached one at a time.

13. 切口将用缝线或手术订书钉缝合.

14. 绷带或敷料将放在切口处.

15. One or more tubes will be put in your chest. These are to remove air, fluid, and blood from the chest and to allow the new lung(s) to expand fully.

16. A thin tube (epidural catheter) may be put in. This is done to send pain medicine into your back. It may be done in the operating room or in the recovery room.

What happens after a lung transplant?

手术后，你可能会被带到恢复室. You will then be taken to the intensive care unit (ICU). This is a ward in a hospital where you will be watched closely. You will be in the ICU for several days. You 会在医院呆7到14天或更长时间吗.

In the ICU

• You will be connected to monitors that will constantly show your 心律，血压，呼吸频率，氧含量.

• The catheter will stay in your bladder until you can pass urine on your own.

• 你的喉咙里会有一根呼吸管连接着 ventilator. 管子会留在原地，直到你能够 breathe on your own. This may be for a few hours up to several days.

• You may have a thin, plastic tube put through your nose and into your stomach. This is to remove air that you swallow. The tube will 当你的肠子恢复正常功能时取出. You will not 可以吃或喝，直到管子被取出.

• 每天要抽取几次血样. These are done to check the health of the new lung(s), and your kidneys, liver, and blood system.

• You may be on special IV medicine to help your blood pressure and 心脏，并控制任何出血问题.

• 护士会根据需要给你开止痛药， through an epidural catheter, or by giving it yourself through a device connected to your IV.

• 一旦呼吸管和胃管被移除，你的 情况稳定了，你可以开始喝水了. Your diet 当你能吃固体食物的时候，可以慢慢地多吃一些.

• Your antirejection (immunosuppression) medicines will be closely watched to make sure you are getting the right dose and the best combination of medicines.

• Nurses, respiratory therapists, and physical therapists will work 陪你开始物理治疗和呼吸练习.

When your healthcare provider feels you are ready, you will be moved from the ICU to a private room on a regular nursing unit or transplant unit. Your recovery will continue there. You will increase your activity by getting out of bed and walking around for longer periods of time. Catheters and tubes will be removed. Your diet will be progress to solid foods.

Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you and your significant family members how to take care of yourself once you are discharged from the hospital.

At home

• Keep the incision clean and dry. Your healthcare provider will give you instructions for careful bathing. The sutures or staples will be removed during a follow-up office visit.

• You should not drive until your healthcare provider says it’s OK. 你可能需要在一段时间内避免其他类型的活动.

出院后你会经常接受随访. These visits may include:

• Blood tests

• Pulmonary function tests

• Chest X-ray

• An exam of the main airways of the lungs using a long, thin tube (bronchoscopy)

• 从肺中取出组织进行检查(活检)

移植团队会解释这些检查的时间表. Your 康复计划将持续数月.

如果您有以下任何一种情况，请致电您的医疗保健提供者:

• Fever of 100.4°F(38°C)或更高，或根据您的医疗建议 team

• Redness or swelling of the incision

• 血液或其他液体从切口流出

• Pain around the incision that gets worse

• Feeling short of breath

• Trouble breathing

Your healthcare provider may give you other instructions after the procedure.

To allow the transplanted lung(s) to survive in your body, you will take 这是你余生对抗排异反应的药物. Each person may react differently to the medicines. Each transplant team has preferences for different medicines. 医疗保健提供者为患者量身定制药物计划 the needs of each person. 在大多数情况下，有三种抗排斥药物 are given. Antirejection medicines affect the way the immune system works, 所以服用这些药物的人感染的风险更高. The doses 这些药物可能会经常改变，这取决于你的反应. While taking these medicines, you will be more likely to have certain infections. These include oral yeast infection (thrush), herpes, and respiratory viruses. For the first few months after surgery, make 一定要避开人群和任何感染的人. Do not hesitate to 在你康复期间，限制来访者进入你的家. Stay away from any people or places where smoking is allowed and do not allow smoking in your home.

Call your transplant team if you have signs of rejection, such as:

• Fever of 100.4°F(38°C)或更高，或根据您的医疗建议 team

• Flu-like symptoms such as body aches

• Fluid in the lung

• Tiredness

• Feeling short of breath

• Cough

• New chest pain