Lung transplant

Risks

A lung transplant is a complex operation and the risk of complications is high.

Some complications are related to theoperation itself. Others are a result of the immunosuppressive medication which is neededto prevent your body rejecting the new lungs.

Some of the complications are discussed below.

Reimplantation response

Reimplantation response is a common complication affecting almost all people with a lung transplant. The effectsof surgery and the interruption to theblood supply cause thelungstofill with fluid.

Symptoms include:

Coughing up blood
shortness of breath
difficulties breathing while lying down

The symptomsare usuallyat theirworstfive days after the transplant. These problems will gradually improve, and most people are free of 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 treats 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 (extreme tiredness), and adry cough are all symptomsof 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 thattypically 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 with additional immunosuppressant medications.

Post-transplantation lymphoproliferative disorder

After having a lung transplant, your risk of developing a lymphoma (usually a non-Hodgkin lymphoma ) is increased. This is known as post-transplantation lymphoproliferative disorder (PTLD).

PTLD occurs when a viral infection(usually the Epstein-Barr virus) develops as a result ofthe immunosuppressants that are used to stop your body rejecting the new organ.

PTLD affects around one in 20 people who have a lung transplant. Most cases occur within the first year of the transplant. It can usually be treated by reducing or withdrawing immunosuppressant therapy .

The Lymphoma Association has more information about lymphomas after organ transplantation (PDF, 232kb) .

Infection

The risk of infection for people who've received a lung transplant is higher than average for a number of reasons, including:

immunosuppressants weaken the immune system, which means 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, whichmeans they're 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, particularly 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, although 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's estimated that one in four people who receive a lung transplant will develop some degree of kidney disease a year after the transplant.

About1 in 14 people will experience kidney failure within a year of their transplant, rising to1 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.