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Advanced Lung Disease Transplant Services

Post Operative Care

After lung transplant surgery, the patient will go to an intensive care unit (ICU) to be monitored closely. The length of time he/she will spend in the ICU will vary based on his/her unique condition. After the patient is stable, he/she will be sent to the special unit in the hospital that cares for lung transplant patients.

Patients will continue to be monitored closely. Family members will be educated on all aspects of caring for the patient during this time. This will include information about medications, activity, follow-up, diet, and any other specific instructions from your transplant team.

What is done to prevent rejection?

Medications must be given for the rest of the patient's life to fight rejection. Each person is unique, and each transplant team has preferences for different medications. Some of the anti-rejection medications most commonly used include the following:

Because anti-rejection medications affect the immune system, people who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making a transplant patient very susceptible to infection. Blood tests are performed periodically to measure the amount of medication in the body to ensure a patient does not get too much or too little of the medication. White blood cells are also an important indicator of how much medication a patient needs.

What about infection?

The risk of infection is especially great in the first few months because higher doses of anti-rejection medicines are given during this time. A lung transplant patient will most likely need to take medications to prevent other infections from occurring. Some of the infections a patient will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses.

Lung transplant follow-up

Each patient will have very close follow-up with the transplant team after leaving the hospital. This will allow for close monitoring of the patient and the function of the transplanted lung.

Follow-up visits may include the following:

Patients who have received a lung transplant will need life-long follow-up with physicians who are specialized in transplant medicine. Keeping appointments with your transplant physician, as well as maintaining contact with the transplant team when signs and symptoms of rejection occur is vital.

Family members, friends, and the recipient, are the first line of defense; they must understand and recognize the signs and symptoms of rejection, and report them as soon as possible to the transplant team.

In the hospital

After the surgery you may be taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored for several days. Alternately, you may be taken directly to the ICU from the operating room. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Lung transplant surgery requires an in-hospital stay of seven to 14 days, or longer.

You will have a tube in your throat so that your breathing can be assisted with a ventilator until you are stable enough to breathe on your own. The breathing tube may remain in place for a few hours up to several days, depending on your situation.

You may have a thin, plastic tube inserted through your nose into your stomach to remove air that you swallow. The tube will be removed when your bowels resume normal function. You will not be able to eat or drink until the tube is removed.

Blood samples will be taken frequently to monitor the status of the new lung(s), as well as other body functions, such as the kidneys, liver, and blood system.

You may be on special IV drips to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these drips will be gradually weaned down and turned off as tolerated.

You may receive pain medication as needed, either by a nurse, through an epidural catheter, or by administering it yourself through a device connected to your intravenous line.

Once the breathing and stomach tubes have been removed and your condition has stabilized, you may start liquids to drink. Your diet may be gradually advanced to more solid foods as tolerated.

Your immunosuppression (anti-rejection) medications will be closely monitored to make sure you are receiving the optimum dose and the best combination of medications.

Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.

When your physician 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 to progress here. Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated.

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

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they were not removed before leaving the hospital.

You should not drive until your physician tells you to. Other activity restrictions may apply.

Follow-up visits will be scheduled frequently after returning home from the hospital. These visits may include blood tests, pulmonary function tests, chest X-ray, bronchoscopy (examination of the main airways of the lungs using a long, thin tube that has a close-focusing telescope on the end for viewing) and biopsy (removal of tissue from the lung for examination under a microscope.) The transplant team will explain the schedule for these tests. The rehabilitation program will continue for many months.

Notify your physician to report any of the following:

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

 

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