Lung transplant - Risks of a lung transplant
- Introduction
- How to prepare for a lung transplant
- How a lung transplant is performed
- Risks of a lung transplant
- Recovering from a lung transplant
- 'My transplant was worth the risk'
- 'I could take a deep breath for the first time in years'
A lung transplant is a complex operation and the risk of complications is high.
Some complications are related to the operation itself. Others are a result of immunosuppressive medication, which is needed to prevent your body rejecting the new lungs.
Some of these complications are discussed below.
Reimplantation response
Reimplantation response is a common complication affecting almost all people with a lung transplant. The effects of surgery and interruption to blood supply causes the lungs to fill with fluid.
Symptoms include:
- coughing up blood
- shortness of breath
- difficulties breathing while lying down
Symptoms are usually at their worst five days after the transplant. These problems will gradually improve, and most people are free of their symptoms by 10 days after their transplant.
Rejection
Rejection is a normal reaction of the body. When a new organ is transplanted, your body's immune system sees it as a threat and produces antibodies against it, which can stop it working properly. Most people experience rejection, usually during the first three months after the transplant.
Shortness of breath, fatigue (feeling tired all the time), and a dry cough are all signs of rejection, although mild cases may not always cause symptoms.
Acute rejection usually responds well to treatment with steroid medication.
Bronchiolitis obliterans syndrome
Bronchiolitis obliterans syndrome (BOS) is another form of rejection that typically occurs in the first year after the transplant, but could occur up to a decade later.
In BOS, the immune system causes the airways inside the lungs to become inflamed, which blocks the flow of oxygen through the lungs.
Symptoms include:
- shortness of breath
- dry cough
- wheezing
BOS may be treated by giving you additional immunosuppressant medications.
Post-transplantation lymphoproliferative disorder
Post-transplantation lymphoproliferative disorders (PTLD) are thought to affect around one in 20 people after a lung transplant.
PTLD is thought to occur when a type of viral infection stimulates abnormally high production of B-cells. This would normally be controlled by T-cells, but the immunosuppressants block the effects of T-cells.
Treatment options will depend on the type of PTLD and where in the body it is situated.
Infection
The risk of infection for people who have received a lung transplant is higher than average for a number of reasons, including:
- immunosuppressants weakening the immune system, meaning an infection is more likely to take hold and a minor infection is more likely to progress to a major infection
- people often have an impaired cough reflex after a transplant meaning that they are unable to clear mucus from their lungs – providing the perfect environment for infection
- surgery can damage the lymphatic system, which usually protects against infection
- people may be resistant to one or more antibiotics as a consequence of their condition, especially those with cystic fibrosis
Common infections after a transplant include:
- bacterial or viral pneumonia
- cytomegalovirus (CMV)
- aspergillosis – a type of fungal infection caused by spores
Long term use of immunosuppressants
Taking immunosuppressant medications is necessary following any type of transplant, though they do increase your risk of developing other health conditions.
These health conditions are described below:
Kidney disease
Kidney disease is a common long-term complication. It is estimated that one in four people who receive a lung transplant will develop some degree of kidney disease a year after the transplant.
About one in 14 people will experience kidney failure within a year of their transplant, rising to one in 10 after five years.
Diabetes
Diabetes, specifically type 2 diabetes, develops in around one in four people a year after the transplant.
Diabetes is treated using a combination of:
- lifestyle changes, such as taking regular exercise
- medication, such as metformin or injections of insulin
High blood pressure
High blood pressure develops in around half of all people a year after a lung transplant and in eight out of 10 people after five years.
High blood pressure can develop due to a side effect of immunosuppressants or as a complication of kidney disease.
Like diabetes, high blood pressure is treated using a combination of lifestyle changes and medication.
Osteoporosis
Osteoporosis (weakening of the bones) usually arises as a side-effect of immunosuppressant use.
Treatment options for osteoporosis include vitamin D supplements (which help strengthen bones) and a type of medication known as bisphosphonates, which help maintain bone density.
Cancers
People who have received a lung transplant have an increased risk of developing cancer at a later date. This would usually be one of the following:
- skin cancer
- lung cancer
- liver cancer
- kidney cancer
- non-Hodgkin lymphoma – which is a cancer of the lymphatic system
Because of this increased risk, regular check-ups for these sorts of cancers may be recommended.
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