Lung transplant surgery
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You may be considering lung transplant surgery if end-stage lung disease has severely damaged your lungs. The lung transplant process is a difficult, life-changing experience. However, the entire Duke lung transplant team – our pre- and post-transplant coordinators, our doctors and surgeons, our nutritionists, rehabilitation specialists, psychologists, social workers and counselors – are here to support you through every step of your journey. If you have a strong desire to live, we help you get your life back, unencumbered by lung disease.
Questions to ask when selecting a lung transplant program
These questions and our answers can help you evaluate whether our lung transplant center meets your needs.
How many lung transplants has your center performed?
- We are a high volume lung transplant program and the largest lung transplant program in the Southeast. More than 1,600 lung transplants have been performed at Duke since 1992. Our lung transplant surgeons performed 108 lung transplants in 2015.
What types of patients receive lung transplants at your center?
- We routinely perform lung transplantation in patients who live near and far with end-stage lung disease related to chronic obstructive pulmonary disease (COPD), cystic fibrosis, pulmonary fibrosis, pulmonary hypertension, scleroderma, sarcoidosis, alpha 1 antitrypsin deficiency and other complex conditions, such as occupational lung diseases and lung disease that results from prior cancer treatments, including bone marrow transplant, radiation and chemotherapy. We are also experienced in performing lung retransplants in people who develop chronic rejection after lung transplant.
What kinds of lung transplants do you perform?
- We perform both single and double lung transplants. Whether you receive a single or double lung transplant depends on many factors, including your underlying disease, prior chest surgeries, and anticipated difficulty in finding a suitable donor for you. While the majority of patients receive double lung transplants, our transplant surgeons develop a customized surgical plan for each patient we transplant.
- For some patients, a lung transplant alone may not be enough to restore their health. Our transplant surgeons are experienced in multi-organ transplants, including heart-lung, lung-liver, lung-kidney transplants and triple transplants of the heart, lungs, and liver.
What is the average wait time for a lung transplant?
- Wait time on our lung transplant list averages about 14 days. The national average is four months. Our short lung transplant wait times are due, in part, to our aggressive and innovative organ-recovery efforts. This approach enables us to procure and successfully transplant more viable organs in more patients who need them. It also eliminates the chance of death while waiting for lung transplant surgery.
How will you help me prepare for lung transplant surgery?
- Our intensive pre-transplant physical therapy and education program is an integral part of the preparation process. Our supervised exercise program ensures your body is strong going into lung transplant surgery.
How well do your patients do following the lung transplant procedure?
- Lung transplantation is a high-risk procedure, so every effort goes into maximizing your chance of doing well.
- We focus on pulmonary rehabilitation and physical fitness because evidence shows that better physical functioning going into transplant improves outcomes.
- Our team has also been instrumental in recognizing the importance of mental health on lung transplant outcomes, so our transplant psychologists work closely with you to make sure you are prepared for the emotional and psychological stress of lung transplantation.
- We employ aggressive strategies to prevent and treat organ rejection. Our efforts positively impact our lung transplant survival rates and increase your life expectancy after lung transplant.
- We successfully perform lung transplants in sicker and older patients. As one of the first U.S. centers to perform lung transplants in patients age 65 and older, we have vast experience in this patient population and the challenges faced. In fact, more than 50 percent of lung patients over the age of 65 in the U.S. choose Duke for their lung transplant. We have experience with patients who have complex illnesses, including multi-drug resistant infections, immunologic deficiencies, coronary artery disease, and valvular heart disease.
Does Duke participate in lung transplantation research?
- Our leadership in lung transplantation research gives you access to the most up-to-date evidence-based practices available.
- We are dedicated to improving the outcomes of lung transplant recipients and know that research drives progress. Our researchers have made significant contributions to the field of lung transplantation, notably our understanding of risk factors for chronic rejection, the impact of CMV infection and gastroesophageal reflux on lung transplant outcomes, and the different forms of chronic lung allograft dysfunction.
- As recipients of a five-year, $13M Clinical Trials in Organ Transplantation (CTOT) grant, we collaborate with four other leading lung transplant centers to advance the understanding of infection and chronic rejection, which affects more than half of lung transplant recipients.
- We have also been a leader in expanding the donor pool through the use of ex-vivo lung perfusion technology.
The lung transplant process
Doing well with after lung transplant surgery isn’t just about your medical condition. That is why our comprehensive evaluation considers your overall health and support system. You will undergo extensive medical testing of your heart, lungs, and gastrointestinal system. You will also meet with a psychologist, nutritionist, pharmacist, social worker and financial coordinator. This lengthy and detailed evaluation allows us to assess whether lung transplantation is a therapy that might benefit you.
If you are considered a candidate for a lung transplant procedure, we help you relocate to Durham so that you can best prepare for the surgery. You will spend several weeks participating in supervised exercise and transplant education classes led by our lung transplant team. You and your caregivers will learn about the lung transplant process, the medications you will take and the recovery process. Read more in our Before Your Lung Transplant guide.
Daily pre-transplant physical therapy is an integral part of our lung transplant program. It is led by a team of respiratory and physical therapists who specialize in preparing patients for lung transplant surgery and recovery. They will monitor your oxygen needs, teach you breathing and stretching techniques to help you after transplant and lead you in exercise to build up your body in preparation for surgery. The stronger you are before the transplant the better chance you have of getting through the surgery without significant complications.
Managing your life and medications after a lung transplant is not easy. Early on, you will need to focus all your efforts on rebuilding your strength and adjusting to your new lungs. Your transplant caregivers will organize your medications, make sure you are taking them correctly and get you to and from all of your medical and physical therapy appointments. Your caregivers are vital partners in your transplant and recovery. We include them in the pre-transplant educational program so that together, you and your caregivers will be prepared for the transplant process and your new life after transplant.
When the time is right, your name will be added to the waitlist for a lung transplant. This is the national database maintained and administered by the United Network for Organ Sharing (UNOS) to allocate donor lungs in the United States. Being “on the list,” means our surgeons are looking for suitable lungs for you. Lungs are allocated based on blood type, distance from donor hospital, and lung allocation score. Our surgeons then look at the details of the donor to decide if it is right for you. Unfortunately, not everyone listed for transplant will receive one, since there are not enough organs available for transplant. However, our rates of death on the waitlist are some of the lowest in the country.
Lung transplant recovery
We ask that you stay in the Durham area for three to six months following your lung transplant, depending on your clinical status, so we can closely monitor your progress and ensure a successful outcome. You will return to physical therapy after the transplant to recover from the surgery, build back your strength and help you become independent again. Although organ rejection can follow transplants, our innovative strategies to treat organ rejection and injury are a documented success. Read more in our After Your Lung Transplant guide.
Our team is dedicated to you and your caregivers. You will be assigned a lung transplant coordinator to facilitate your ongoing care needs. For urgent needs, one is on-call 24 hours per day, 365 days per year. Additionally, a lung transplant physician is on call at all times if your local provider needs to reach us. We offer a formal caregiver support group, coping skills training program, and nonpharmacologic pain management strategy class at our rehab center. Many patients and caregivers find the community of other patients who are also preparing for and recovering from, their lung transplants at Duke to be invaluable through this challenging process.