Lung Transplantation | Surgery & Hospital Stay

Lung transplant surgery

When an organ does become available, time is of the essence, so it is important to be at the hospital within four hours of getting the initial call. When you arrive at Boston Children’s Hospital, you will go to the Solid Organ Transplant Floor or the intensive care unit (ICU).

The doctors and nurses will examine your child, obtain certain specimens, take a chest radiograph and draw some blood. This is to make sure your child is ready to go to the operating room. If your child has an upper respiratory infection or a temperature, the transplant team will then determine whether or not it is safe to go ahead with the operation.

You will meet and discuss the upcoming surgery with the surgeon and anesthesiologist. This is a good opportunity to go over any questions or concerns you might have and sign consent forms.

While the preparation for surgery takes place, a surgical team is leaving Boston Children’s Hospital to obtain the donor lungs. The time of the operation is planned to match the team’s arrival back to Boston Children’s.

Lungs need to be transplanted soon after being outside of the body. Timing is crucial in order to remove the lungs, transport them back to our hospital and get them transplanted within that time frame.

The surgery can take anywhere from six to eight hours. While your child is in surgery, your family will be given progress reports every few hours.

Possible complications after lung transplant

Rejection

Rejection is a normal reaction of the body to a foreign object. The immune system is responsible for the body’s defense against infection and foreign tissue (the transplanted organ). Because a lung transplant is viewed by the body’s immune system as foreign, the body mounts an attack against the transplanted lungs by sending cells from the immune system to destroy the new lungs. This attack is called rejection.

To minimize the chance of rejection, we start immunosuppressive medications during the transplant surgery. These medications work to inhibit the immune system and prevent rejection of the new lungs. Since these drugs inhibit or decrease immune response, it can put your child at risk for infection that is caused by bacteria, viruses and fungi.

The more common immunosuppressive medications are prednisone, Cellcept and Prograf. The first year after your transplant is often when we are working to establish the best combination of anti-rejection medications. The immunosuppressive medications are taken at the same time every day, and your child will need to take them for the rest of their life.

After transplant, we periodically test for rejection. This is typically done during a bronchoscopy, by taking a very small piece of the new lungs and looking at the cells under a microscope, called a lung biopsy. If there are any signs of rejection, we will develop a plan to treat the rejection.

Infection

The immunosuppressive medications that prevent rejection of your child’s new lungs cause your child to be more susceptible to infection. Some of the infections your child may be especially susceptible to include:

  • oral yeast infections (thrush)
  • viral infections such as CMV, EBV, herpes
  • respiratory viruses
  • bacterial infections

This risk of infections is especially high during the first few months after the transplant. This is because higher doses of anti-rejection medicines are given, so the immune system is especially suppressed.

Hospital stay after lung transplant

After surgery, you will remain in the intensive care unit (ICU) for several days. As your condition improves, you will be transferred to the solid organ transplant floor, where your recovery will continue. The lung transplant team along with the nurses on the floor will teach your child and family about the medication schedule, monitoring for side effects and complications related to the transplant. We will tailor the information and develop a plan that suits your child’s individual needs. We encourage the extended family to be involved in learning about your child’s care when you go home.

Going home after lung transplant

Once discharged from the hospital, you and your family will be responsible for looking after your child’s health and contacting your transplant team if any problems should arise.

Oftentimes, we arrange for a visiting nurse to come to your home to assess your child’s progress and monitor for any changes when you are initially discharged after the lung transplant.

Medications

The goal after transplant is to use the lowest dose of medication possible to prevent rejection and minimize side effects. Using drugs in combination allows us to use smaller doses for each drug than if only one drug is used. We generally use a combination of drugs to suppress your child’s immune response. Taking the medications prescribed in the right amount and at the right time every day is essential to good health after transplant.

Your child will be given a medication schedule before leaving the hospital and during clinic visits. Changes are made to medication doses frequently by the transplant team.

Just like the nurses and pharmacists work with patient and families to understand meds, the nurse and dietitian will work with families to understand nutrition needs and restrictions.