What To Expect Before and After Lung Transplant

Prepared By: Sandra Tindle, RRT Cardiac/Pulmonary Rehabilitation

Coordinator

Before Lung Transplant

• You will be referred to see the transplant pulmonologist by your doctor.

• You may have many appointments with the transplant pulmonologist before he decides that you are ready for the surgery.

• You will be expected to go through a rigorous evaluation process.

Transplant Evaluation

Transplant Evaluation

• The transplant evaluation usually takes 3-7 days.• You will meet the entire transplant team: nurses,

surgeons, doctors, therapists, and social workers.• The transplant pulmonologist orders the testing that

he thinks you need to have during the evaluation. This usually depends on age and the disease you have.

• Usually consists of blood work, x-rays, echo, heart cath, ABG, 6 minute walk test, liver and bone scans, and PFTs.

Pulmonary Rehab

Pulmonary Rehab

• You will be enrolled in a Pulmonary Rehab program, if you aren’t already enrolled in one.

• You will be monitored during exercise and be placed on O2 if needed.

• You will be instructed on breathing exercises and coordinated breathing.

• You should be instructed on exercises for muscle strengthening, flexibility, and endurance.

• Rehab sessions should meet for a minimum of 3 times per week, preferably 4-5 times per week.

In The Hospital

In The Hospital

• After surgery you will be taken to the SICU. • You will probably still have a tube in your mouth.• You will probably still be on the ventilator.• You will have tubes in your chest to drain

air/fluid.• You will have a catheter in your bladder.• You will have a catheter in your wrist to monitor

blood pressures.

In The Hospital

• If you’re having a single lung transplant, your incision will be on your side.

• If you’re having a double lung transplant, your incision will be just at the base of your breast.

• You will stay in SICU for 2-7 days after surgery.• You will be visited by respiratory therapists,

pulmonary rehab, and physical therapy. These specialists will help you to keep your strength and mobility while recovering.

In The Hospital• Once you have moved out of SICU and into a regular room,

someone from the team will be in to visit with you everyday to teach you and your caregivers how to take care of your new lungs and how and when to take your new medications.

• You will be given a spirometer to monitor you lung function twice every day.

• You will also have at least one bronchoscopy. This procedure allows the doctor to place a camera in your lungs, and also to take samples of tissue from the lungs to look for viruses or rejection.

• Most people are discharged 1-4 weeks after transplant.

After Discharge

• You and your caregiver will need to stay close to your transplant center for at least 3 months after transplant. How close depends on what your center deems as acceptable.

• Vanderbilt patients must stay within 10 minutes of Vanderbilt.

• You will need a backup caregiver in case you first caregiver has an emergency and isn’t available.

• You will have to go through much testing during the first 3 months after transplant.

After Discharge

After Discharge

• Transplant is a life long commitment. • You will need to take your medications on a set

schedule. Set an alarm so you don’t miss them.• You may have to change your diet to fit your

nutritional needs.• You may have to change your habits: buffet

restaurants may be out of the question, as well as meat that isn’t cooked to the recommended temperature. You may also have to stop drinking fountain drinks.

Anti-Rejection Medications• Prograf: take twice/day at the same times every day. Side

effects: toxic on kidneys, increased BP, swollen or bleeding gums, shaky hands.

• Cellcept: take twice/day at the same times every day. Side effects: infection, mouth sores, anemia, nausea/diarrhea, hair loss

• Prednisone: prevents inflammation. Side effects: weight gain, indigestion, acne, slower healing, mood swings, insomnia, increased blood sugars.

• Cyclosporine: prevents rejection. Side effects: tremors, headache, dizziness, insomnia, nausea, high blood pressure.

Preventive Medications

Preventive Medications• Bactrim: prevents pneumonia and treats infection. • Inhaled amphotericin lipid complex: prevents fungal

infection.• Anti-reflux: you will be on one type of this medication for the

rest of your life, even if you don’t have reflux problems now. This helps prevent your new lungs from problems with reflux in the future, possibly due to new meds.

• You will be on medication to prevent certain types of viral infections.

• Nystatin: prevents thrush• Lasix: prevents fluid buildup.

Preventive Medications• Sporanox: prevents fungal infections.• You will also take calcium and magnesium and vitamin D

because prednisone affects the calcium stored in the body.

• Anti-hypertensives: you will probably need to take a medication to lower your BP at some point since the anti-rejection meds can cause you to have a high BP.

• There are many, many OTC medications that will not react well with your new medications. ASK YOUR TRANSPLANT TEAM BEFORE YOU TAKE ANY OTC MEDICATIONS.

Important Facts

Important Facts• One of the leading causes of rejection is not taking

medications correctly.• If you are unable to take your medications due to nausea or

vomiting CALL YOUR TRANSPLANT TEAM IMMEDIATELY!• Do not store your medications in your car.• Do not cut or crush your medications unless you are

advised to do so.• NEVER start or stop ANY medication without the transplant

team’s approval.• YOU are responsible for taking your medications correctly.

Questions?