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>> The opportunity for a new life occurs every day
at the University of Michigan Transplant Center.
Lung transplantation is the surgical replacement of either one or two badly diseased lungs
with healthy lungs from a human organ donor.
More than 500 patients have undergone transplantation
in the lung transplant program at the University of Michigan.
Transplantation allows patients with debilitating lung disease
to return to normal, productive lives.
However, the road to lung transplantation can be a challenging
and sometimes confusing journey for our patients.
Here's a timeline for the transplant process.
Your physician refers you to the University of Michigan because he or she feels
that lung transplantation is the only available treatment option.
You undergo a medical evaluation to determine
if you are a suitable candidate for transplantation.
You will also have a surgical evaluation to determine if you are strong enough
to withstand the rigors of transplant surgery.
If you are found to be a suitable candidate for lung transplantation,
you will be placed on the wait list.
Once new lungs become available, you will undergo transplant surgery.
After surgery, you will begin to recover and learn to live with your new lungs.
As a successful transplant recipient,
you'll continue with specialized care for the rest of your life.
Every aspect of your life will be affected by lung transplantation.
We have assembled a multi-disciplinary team of health professionals dedicated to guiding you
to successful transplantation and returning you to everyday life.
During this video you will meet the different members of the team
and learn how they will help you make the most of this life changing opportunity.
This video will walk you through the entire process and answer many of your questions
as you begin your transplant journey.
We will cover who is eligible for a lung transplant, the transplant process,
getting ready for transplant, the surgical procedure, aftercare procedures,
possible complications, adjusting to your new life
after transplantation and lifelong follow-up.
Transplantation is done for a variety of conditions.
Emphysema, pulmonary fibrosis, cystic fibrosis,
and primary pulmonary hypertension are the most common conditions treated with transplant.
The success of lung transplantation has lead to expanded indications for transplantation.
Unfortunately, there just aren't enough donor lungs to meet the demand.
There are many treatments for these different lung conditions.
Supplemental oxygen will help increase oxygen levels in your blood.
Medicines will help you feel better and may improve how long you live.
These also become less effective over time as your lung disease progresses.
The decision to consider transplantation is made
when your physician feels there is no other treatment for your lung disease.
You will be referred to one of our pulmonologist for evaluation.
As we begin, it is important to talk about how lung transplantation differs
from other solid organ transplants.
The heart, liver, and kidneys are all contained completely inside the body.
Lungs are large solid organs that while contained
in the chest are constantly exposed to the external environment.
Everything we inhale goes through the lungs.
These are like big filters.
There are a lot of cells within the lungs that protect us from getting infections.
You can inhale any type of virus, bacteria, or fungi through the lungs as well.
After transplantation, you will be on many medications that suppress your immune system
so you're body can accept the new lungs and not reject them.
Because of this and the constant exposure to the external environment, we have more problems
of infections and organ rejection with lung transplantation than with other organs.
That in combination with the fact that there are not just
that many donor lungs available has made identifying eligible,
transplant candidates extremely important.
Consequently, your medical transplant evaluation will probably be the most thorough exam you've
ever had.
Your medical evaluation will be performed by one of our transplant pulmonologist.
During this exam your pulmonologist assesses the extent of your lung disease
and your medical suitability for transplantation and discusses the significance
of transplantation including the risk and complications.
Your pulmonologist also manages transplant related medical needs prior to transplantation,
participates in care during the transplant hospital admission,
monitors immunosuppressive medications
and manages your medical care following lung transplantation after discharge.
To start this exam, you will have a lot of blood drawn.
Many tests are run so your pulmonologist can get a picture of your overall health.
Your blood will also be tested for the presence of nicotine,
chronic substance use, alcohol, and illicit drug use.
If you were a smoker, you have to be smoke free
for at least six months prior to your evaluation.
This includes any nicotine containing products such as gum or patches.
If you continue to smoke you will not be a candidate for transplant.
Any evidence of chronic substance use, heavy alcohol use,
or illicit drug use makes you ineligible for a transplant evaluation.
You must cease using these substances for at least six months prior to evaluation.
Your weight and nutritional status are also important factors
when we're evaluating you for transplant.
If you are too skinny, you may be malnourished with all
of your calories going towards helping you breathe.
Underweight patients do not do well after transplant surgery.
On the other hand, obese patients tend not to do well after surgery either.
To frame this discussion about your weight, your pulmonologist will use the body mass index
and discuss the specifics with you.
You will be required to participate in an exercise program.
Lung transplantation is a big operation.
You need to be in the best physical shape possible to prepare for this surgery.
Exercise will help condition you for surgery.
You will also be asked to perform a six minute hall walk.
During this time, you must be able to walk at least 450 feet.
As we have said before, lung transplantation is a big surgery.
You must be strong enough going into the surgery to be able to recover successfully.
If you are already in a wheelchair and cannot walk because of shortness of breath,
you may be too weak to be a candidate.
Other test you will need include a cotinine test, chest x-ray,
24 hour pH probe, and an arterial blood gas.
Since you'll be on corticosteroids after transplant,
you'll need a bone densitometry test.
Corticosteroids can break down your bones over time and you have to treat
that effectively to prevent any complications.
Certain test like colonoscopy, mammograms, pap smear, and ***
and prostate exams maybe handled by your primary care physician.
Your regular physician is also instrumental in managing other health maintenance issues
like immunizations for hepatitis A and B as well as testing for tuberculosis.
You will need to get medical clearance from your dentist as well.
Let's look at some reasons you may not be eligibility for lung transplantation.
Many of the anti-rejection medicines we use actually speed up the growth of cancer cells.
If you have a history of cancer, you must be cancer free
for at least five years before we will consider you for lung transplantation.
The only exception to the five year period is skin cancer.
Your blood will also be screened for any incurable viral infections
such as active hepatitis C or human immunodeficiency virus or ***.
If you have either of these you cannot be a candidate in our program.
Some programs will transplant hepatitis C donor organs into someone who has hepatitis C
but we do not do that in the lung program at the University of Michigan.
There are other conditions that may make you ineligible for lung transplant.
If you are chronically ventilator dependent, have active
or current antibiotic resistant infections, suffer from an incapacitating mental illness,
have systemic disorders such as connected tissue diseases, demyelization disorders,
or are nursing home dependent we cannot consider you for transplantation.
The journey towards lung transplantation has many steps.
Once your pulmonologist determines your preliminary eligibility for lung transplant,
you will meet with your transplant coordinator.
You will need to have numerous blood test, imaging studies, and diagnostic tests.
You will need to attend a lung transplant education class with your caregivers.
You will need to attend a social work evaluation, meet with a financial coordinator,
a transplant pharmacist, and a transplant nurse.
This is a dizzying list of meetings and obligations.
We don't expect that you'll be able to find your way on your own.
You will have a transplant coordinator to help you.
During the class, you're coordinator will provide you with valuable information
and answer any questions you may have about the transplantation process.
Your transplant coordinator will help you schedule the necessary tests
and imaging studies.
As you start down the road to transplantation,
you'll find that your transplant coordinator is central
to coordinating the care you will receive from all
of the members of the multi-disciplinary team.
You must keep in touch with your transplant coordinator.
While you're waiting to get listed,
your pre-transplant coordinator will help keep you on track.
All transplant candidates and their caregivers must attend a long transplant education class.
Your caregivers are required to come to this class.
The class is led by the transplant coordinators.
You will meet with members of our transplant team, social workers, nurses,
pharmacists, and financial coordinators.
This class will teach you what you need to know about the many aspects of lung transplantation.
They will lead an in-depth discussion about everything in this video.
Written educational materials are provided.
You will receive a copy of the lung transplant notebook.
This is a valuable resource for you to refer back to as you proceed
on your journey towards transplantation.
A transplant social work evaluation is mandatory.
Your social worker will gather valuable information about you, your family,
coping abilities, substance abuse history, mental health history, support systems,
financial stressors, and your ability to follow important post-transplant instructions.
This information helps the social worker assess your needs before and after your transplant.
The ability to cope with high stress situations is extremely important
to be a good transplant candidate.
Even when the transplant goes well it can be stressful.
When it doesn't, it can be a really rough ride for you and your family.
Your tolerance for high stress will be evaluated fully by your social worker.
Also, we use very high doses of prednisone after transplant.
You may be familiar with this medication well enough to know
that it can make you very manic or very depressed.
This can have a negative effect if you already have a history of depression and anxiety.
Another important eligibility factor is a strong psycho-social network.
Having family or friends help you after transplant is essential to your recovery.
After your surgery, we require that you stay close
to the university for at least three months.
This is the most critical time after transplant.
It can be a very difficult and lonely time without the comfort of family and friends.
Your social worker will also evaluate your ability to take care of yourself,
to keep appointments, and to remain compliant with your medications as well as to cooperate
with us so we can help you adjust to life after transplant.
Using this thorough evaluation, your social worker will help you recognize
and strengthen your existing relationships, identify resources you'll need,
and develop strategies that will ensure you have the support necessary
for a successful transplant experience.
Also, your social worker runs a support group meeting for lung transplant candidates,
patients, recipients, and their caregivers.
This group meets once a month and shares information on all aspects of transplantation.
Your participation in the support group will help you cope with the anxiety while waiting
for a new lung as well as the challenges you'll face once your surgery is over.
As you can see by now there is a lot of preparation and planning
for lung transplantation, not just for the surgery but for the financial side as well.
Transplantation is costly.
There are the doctor visits, tests, surgery, hospital stays, and medication.
Also, there are a variety other out of pocket expenses such as travel,
lodging and meals, to name a few.
We have a team of transplant financial coordinators who are here to help you.
The first step in financial planning is finding out what your insurance covers.
Each phase of the transplant process may have a separate level of coverage,
maximum allowable limits, or exclusions.
We have developed a benefits questionnaire to help guide you
through discussions with your insurance carrier.
Your transplant financial coordinator will guide you through this
so you'll understand what your insurance will and will not cover.
Obtaining the required referrals and prior authorizations can make the difference
between covered expenses and huge medical bills for which you would be responsible.
Your transplant financial coordinator can work with you
to get the referrals and authorizations you need.
Uncovered expenses can be financially devastating.
Once you start down the road to transplantation, you must stay insured.
Communicate any changes in your insurance, no matter how small,
to your transplant financial coordinator.
After your transplant, you will be on several medications for the rest of your life.
These are essential to your health and the continued success of your transplant.
These medications are very expensive and for patients without insurance, unaffordable,
for this reason, it is imperative to maintain continuous insurance coverage
for healthcare service and medications.
Your transplant financial coordinator will help you understand your coverage
and plan for your medical expenses.
If you are thinking of changing your insurance, consult your financial coordinator prior
to making the change to discuss the complexity of insurance coverage for transplantation.
It is important to remember that some insurance plans require you to receive services
at a medical center within their list of providers.
Some coverage may not allow you to be treated at the University of Michigan.
Lapses in your insurance coverage after you are listed for transplant may require you're listing
to be placed on hold until you can obtain insurance coverage.
Each change in coverage requires new authorizations
for transplant requiring your status to remain on hold until those can be obtained.
You must stay in contact with your transplant financial coordinator even
after your transplant.
If you need assistance such as Medicare or Medicaid,
your financial coordinator will help you understand your options.
If you are currently experiencing financial hardship, your transplant social worker can help
by discussing your options and managing these challenges.
Your transplant financial coordinator and your transplant social worker are available to work
with you in addressing your needs.
Before meeting with the surgeon there are several tests and imaging studies you must have.
Your pre-transplant coordinator will help you schedule these tests.
All tests and imaging studies need to be completed before your surgical evaluation.
Having sick lungs, no matter what the cause, makes your heart work harder.
You'll undergo a chest CT scan and complete pulmonary function testing.
The CT scan provides detailed views of your lungs.
Your pulmonary function test results will show how well your lungs are working.
Several of the imaging studies will look at the condition
of your heart and the vessels that supply it.
You will have an EKG and an echo cardiogram.
The thoracic surgeon will review your test results and imaging studies,
discuss the results, the surgical process, risks and the benefits
of lung transplantation with you.
If the surgeon determines that you may be good candidate
for lung transplantation then your evaluation will continue.
Additional required testing will be ordered after the surgical evaluation.
If these tests reveal significant liver, kidney,
or heart abnormalities you may not be eligible for a transplant.
You will need to undergo a VQ perfusion test and a cardiac catheterization of your right heart
and possibly your left heart too.
The VQ test evaluates your lung ability for ventilation and perfusion.
In other words, this test determines which lung is in worse condition by looking
at where the oxygen and blood is going in the lungs.
It is important to remember that the thoracic surgeon you see
for evaluation may not be the surgeon who performs your surgery.
As we've mentioned before, the most important limiting factor in the number
of lung transplantations performed nationwide is the lack of suitable donors.
That means that every year there are more people who need a lung transplant than can get one.
Therefore, it is important that these available donor organs are allocated carefully and fairly.
As with other organ transplants, there is a waiting list for patients needing donor lungs.
The organ procurement and transplantation network or OPTN which is managed
by the United Network for Organ Sharing
or UNOS maintains the only national patient waiting list for organ transplantation.
Once you have successfully completed your medical and surgical evaluations,
your case will be referred
to our multi-disciplinary lung transplant evaluation team.
Each case is presented and discussed in depth.
After a full review of your individual case, the team will make a recommendation
about whether you can benefit from lung transplantation and if you meet the criteria
to be placed on the waiting list.
After your case has been reviewed and you are listed,
your transplant team will determine whether a single
or a double lung transplant is needed based on your medical condition and history.
It is important to remember that not everyone can be wait-listed for new lungs.
The evaluation team may determine that you are too sick to benefit from a transplant
or your physical condition is too diminished to withstand the rigors of surgery.
If this happens, your pulmonologist will continue caring for you
in giving you the best care possible.
Once you're on the list, you will be given a lung allocation score.
It is a number that comes from your condition, the results of your physical exam,
diagnostic testing and it reflects how sick you are.
It is used to determine your placement on the waiting list.
With the lung allocation score, whoever is the sickest will go to the top of the list.
When lungs become available, a suitable match is based on blood type and size.
So if an organ becomes available that's from a donor matching your blood type
and is of the correct size for you, your surgeon will then evaluate that lung.
If it is suitable for transplantation you will likely be offered that lung.
Getting listed comes with responsibilities.
While waiting for new lungs to come you must stay in close contact with the transplant team.
Once suitable lungs become available the transplant coordinators have one hour
to contact you.
Transplant coordinators must speak to you.
They will not leave a message on your answering machine telling you new lungs are available.
Therefore, you must supply current phone numbers and be reachable when the call comes.
If you're relying on the cell phone,
make sure you are in a cell phone reception area otherwise you may miss this call.
An hour goes by very quickly.
Due to the limited supply of donor organs, this may be your only chance for a transplant.
Once you are listed you should stay within a four hour radius of Ann Arbor.
If you are outside of this radius, you will need to arrange for air transport to get here
in the four hour window after the call comes or you will need
to be placed on hold for a transplant.
Talk to the social worker if you need help with advanced directives,
a durable power of attorney, or a living will.
If your health or medications change while you are on the list tell your coordinator.
This includes getting a cold, flu, or infection.
If you are hospitalized or your breathing deteriorates, you're placed on antibiotics,
your prednisone dose changes, you experience a change
in your oxygen need tell your coordinator.
We can't perform a lung transplant while you are sick.
Therefore, your status on the list would change to on-hold until you're well again.
Other reasons that may cause your status to change
to on-hold include changes or lapses in your insurance.
There maybe social issues that cause you to put your wait list status on hold.
It is your responsibility to maintain good health to the best
of your ability while waiting for a transplant.
However, if you choose not to follow the substance abuse policy, miss appointments,
won't take your medications, don't follow your long transplant teams recommendations,
and don't get your lab tests as required you can be removed from the list.
It is helpful to have developed your own plan for how you will get
to the hospital when the call comes.
Don't forget to plan for childcare, pet care, temporary lodging and meals
for your family during and after your transplant.
Don't forget to plan for added expenses such as the cost of parking at the hospital.
Consider whether you will have a loss of income during this time
and plan for how to manage your expenses.
Be prepared.
Review your plan periodically and make changes as necessary to stay prepared.
The call to offer you a donated organ can come anytime
but it often comes in the middle of the night.
It is important to always answer your phone,
even when you do not recognize the caller's telephone number.
Once the call comes, you'll be instructed to come to the University
of Michigan Cardiovascular Center or CVC for your transplant,
stop eating and drinking immediately.
Drive carefully and wear your seatbelt.
Be sure to bring the essentials you have packed
for this trip including telephone numbers you may need and money for parking.
Bring your medications and enough oxygen for a round trip to and from the hospital.
Please bring your Patient Education Guide as that will be used after your surgery to teach
about the medications you will take and how to care for yourself when you go home.
When you arrive at the CVC, proceed to the area of the hospital as instructed
by the transplant coordinator who called you.
A clinical trial also call a Research Study is a study that helps test whether a new treatment
or medication is safe and effective or whether older treatments produce the best results.
In organ transplants, previous studies have been very important
in finding the best way to care for your new organ.
Clinical trials have been found to be the best way to make sure new drugs,
devices and procedures are safe and effective.
Prior to surgery, you may be asked to participate in one of these studies.
You are not required to join.
You must volunteer in order to be able to take part in a clinical trial.
A decision should be made after you have full knowledge of what is involved.
Taking part in a clinical trial may or may not improve your health.
You may be one of the first to try a promising new drug
or you might receive the standard or regular therapy.
All clinical trials are reviewed and approved by a safety
and ethics board before any patient can be enrolled in a study.
Patients will meet with a member of the clinical research team who will explain the studies
and answer questions before the patient makes a decision.
Each patient enrolled in a clinical trial is monitored very closely while participating
in this study.
Whether you choose to join a study or not, you will be cared for by the transplant center team
of dedicated professionals who are interested in your health.
One of the most important reasons for joining a clinical trial is a desire
to help advance what is known about new treatments.
Before starting the operation, you will have several tubes and lines placed.
First, your anesthesiologist places several intravenous or IV lines.
These will deliver fluids as well as medications
to make sure you are comfortable and send you off to sleep.
A pulmonary artery catheter is a long flexible tube that is placed into a large neck vein
and extends to the pulmonary artery.
It provides a way to monitor your heart's function.
Medications and IV fluids can also be delivered to your bloodstream through this catheter.
The arterial line is inserted into an artery usually in your wrist or groin.
It records your blood pressure on the monitor.
It also allows the transplant team to access samples
of your blood without repeated needle sticks.
Your anesthesiologist will monitor all your vital signs throughout the operation.
Next an endotracheal tube will be inserted through your mouth
into your trachea, also known as your windpipe.
It connects to a ventilator, it will breath
for you while you are under the affects of anesthesia.
The nasogastric tube or NG Tube is a long flexible tube
that is inserted either through your nose or mouth.
It is then passed into the stomach.
This tube keeps your stomach empty while you're on the ventilator.
You will also have a urinary catheter placed.
This drains urine from your bladder.
It helps the doctors and nurses monitor your kidney function and your body temperature.
The catheter is placed when you are asleep in the operating room.
To begin the lung transplant operation, you're surgeon will make an incision on your chest.
The type of incision made depends
on whether you're getting the single or double lung transplant.
For a single lung transplant, you're surgeon will make an incision on the same side
of your chest as the lung that is being replaced, this is called a thorocotomy.
The incision starts on the side of the mid chest and goes around to the back of the chest usually
in the space between the forth and fifth ribs.
For a double lung transplant, your surgeon will make a clam shell incision.
Cuts are made across the breast bone and extended under each breast area.
Surgical cuts of ribs and sternum are necessary to access your lungs.
Once the chest is open the surgeon now has good exposure to the lungs.
The lung that is to be removed will be deflated using a special breathing tube.
At this time, you will be breathing with only one lung.
Your surgeon may or may not choose to use the heart-lung bypass machine
to help supply oxygen rich blood to your body.
Your old lung is removed and your new healthy lung is placed inside your body.
If you are receiving a double lung transplant this process is repeated on the other side.
Chest tubes will be placed to remove drainage from your chest
and help keep your new lung inflated.
Your surgeon will then close your incision.
Next you will be taken to the cardiovascular intensive care unit or CVC ICU to start
on the road to recovery with your new lung.
There are risks associated with any surgery.
Lung transplantation is no exception.
Bleeding can occur during this operation.
Depending on the quality of your lung tissue, there could be bleeding along the staple line.
If bleeding occurs, blood can build up around the lung.
You may have to go back to the operating room to have it removed.
Poor lung inflation or atelectasis can develop after surgery.
If you think of a brand new balloon when you blow into it,
the air doesn't blow the balloon evenly usually the part of the balloon farthest
from the whole inflates the slowest.
Your lungs after surgery are like that balloon.
Secretions accumulate in poorly inflated lungs and make it very hard to breathe.
Phenomena can develop as a result of poor lung inflation not clearing your secretions
and not walking after surgery.
You may develop a pneumothorax or a collapsed lung when your chest tube is removed
and you're lung hasn't healed completely.
If this happens, your chest tube will be reinserted.
Here is a list of possible complications immediately following surgery.
Irregular heart rate, low blood pressure, elevated blood sugar requiring insulin,
blood clots, and kidney problems.
Your condition and progress is carefully monitored while you are in the CVC ICU.
Should any of these complications arise you will be well cared for and these conditions treated.
When you awake from surgery, you will wake
up in the cardiovascular center intensive care unit also known as the CVC ICU.
Your loved ones will be able to visit you based
on your medical condition and unit visiting policies.
You will be in the CVC ICU for approximately three to five days.
Your length of stay is determined by how well you progress after surgery.
It is hard to breathe on your own after lung transplant.
You will be hooked up to a mechanical breathing machine also known
as a ventilator that will be breathing for you.
The ventilator helps you until you can breathe on your own.
Once you are able to breathe on your own, the breathing tube and NG tube will be removed.
The pulmonary artery catheter may be removed one to two days after surgery.
Your arterial line will be removed before you are transferred from the CVC ICU.
You will have chest tubes in place.
You may also have drains as well.
The chest tubes help drain any excess fluid from your chest cavity.
These make it easier to breathe and keep the lungs inflated.
The number of chest tubes you have depends on whether you had one or two lungs transplanted.
These will be removed based on your chest x-ray
and once there is little drainage coming out of your chest.
Expect to be up and walking soon after surgery.
While this maybe painful, it is important for you to maintain your strength
and exercise your new lung as soon as possible.
Getting out of bed and walking will decrease your chance of getting phenomena
or developing blood clots in your legs.
Once you are stable, you will be transferred to the step down unit.
Remember that you are in partnership with your transplant team
and we need your active participation with many things as you heal from surgery.
First, let's talk about how you'll feel after surgery.
You will probably have an epidural catheter placed in your back for pain management.
When this comes out, you will feel pain at the incision site.
Pain after this surgery is normal.
This is a big surgery with muscles being cut and ribs being surgically fractured.
You will be given strong pain medication to keep you comfortable.
You will probably experience nausea.
After surgery, you'll be taking a lot of new medicines
and frequently these will make you feel a little nauseated.
That is important to understand.
Many patients report feeling this funny discomfort under their ribs,
beneath the incision, some call it pain but the sensaton is due more to tightness then pain.
The layers of the incision swell as they begin to heal.
This swelling contributes to this tightness.
Often times this sensation lasts for many months.
Even though everything is working fine and the lung functions are normal,
you may still have this tightness underneath your ribs.
It is something you may have to get used to.
Your surgically fractured ribs will also be sore.
The number of ribs involved depends on the exposure needed by your surgeon.
Your surgeon may need to remove a portion of your rib as well.
That's important to understand too.
You may experience swelling because you're getting so many fluids after surgery,
whether it's in your arms or legs, this is a common occurrence but over time it resolves.
These are all normal sensations and outcomes from surgery.
Now, let's talk about what you need to do to recover.
You must use your incentive spirometer everyday.
Using it will help teach your lungs how to breathe deeply again.
You will need to practice with it four times an hour everyday taking 10 deep breaths at a time.
This will also help you learn how to cough again.
Coughing will help you clear secretions from your lungs
and prevent phenomena from developing.
You will also have drains to collect any fluid from your chest.
You will learn how to empty your drains and measure the output.
As you start to heal, the output will go down.
Barring any complications, you'll be discharged in seven to 14 days depending
on chest tube output, medication understanding, walking ability,
and how well your new lung is functioning.
Rejection is the normal response of the body's immune system to protect you from infection.
Rejection is basically inflammation.
It happens when your body recognizes your new organ is foreign and tries to destroy it.
It can be scary to hear that you have rejection.
However, it is important to remember that almost everyone will encounter this complication.
In spite of all precautions an acute rejection episode is very common
in the first year after transplant.
Keep in mind that your immune system is just trying to protect you.
When this happens your transplanted organ becomes puffy with fluid
and some of the tissue can be injured.
You may experience some shortness of breath or not have any symptoms at all.
If the injury becomes too great your transplanted organ won't work properly.
Most episodes of acute rejection can be successfully reversed
with early detection and special medications.
Some things that can lead to the development of rejection include previous episodes
of rejection, patient noncompliance of medications, not taking correctly
or not taking at all and infection.
Signs and symptoms of rejection are similar to signs of an infection.
They include increased shortness of breath, cough, fatigue, or tiredness;
fever of 100.5 degrees Fahrenheit or higher, chills, muscle aches,
flu-like symptoms, not feeling right.
Keep in mind that while you may have one or more of these symptoms,
often people do not experience any symptoms whatsoever.
This does not mean that your rejection is any less severe.
All rejections should be taken seriously.
Notify your transplant coordinator immediately if you have any of these symptoms.
Now that you are immunosuppressed, it is vital
that you pay close attention to your body when you go home.
You should contact your transplant coordinator if you note any of the following signs
of infection, increased redness, drainage or tenderness of your incisions,
a temperature exceeding 100 degrees Fahrenheit by mouth or persistent low grade temperature 99
to 100 degrees Fahrenheit for more than three days.
A new cough lasting more than two days, increasing shortness of breath,
or burning when you urinate or feeling the need to urinate frequently.
There are several different causes of infection bacterial, viral, fungal, and parasitic.
All of these are very dangerous and should be avoided.
There are specific drugs to treat each type of infection.
You will learn more about these in your lung transplant class.
You should check with your post-transplant coordinator before receiving any vaccinations
or immunizations.
Vaccines made with live viruses pose a risk because the viruses can be transmitted to you.
Before you have any dental work done or any type of medical procedure where a device is inserted
into your mouth, throat, lungs, esophagus,
or genitourinary tract you should be taking antibiotics to prevent infection.
There are things all around you that can make you very sick.
You must take proper precautious to guard against infection, proper hand washing,
avoiding improperly cooked or stored food, avoiding cat litter boxes, wearing a mask
and gloves when gardening can also help minimize your risk of infection.
Your immune system protects you by fighting infections and foreign bodies.
Your immune system will recognize a newly transplanted organ
as a foreign body and will fight against it.
Medications called immunosuppressive drugs are used to prevent your body
from rejecting your newly transplanted organ.
You will need to take immunosuppressive medications for your lifetime.
These medications are very expensive, costing between two thousand
and four thousand dollars every month.
You will need to work with your financial coordinator to develop a sound insurance
and financial plan to cover the cost of these medications.
As a transplant recipient, you will begin taking new medications the day of
or the day after your transplant.
You will take medications to prevent rejection,
to prevent infection and other medications as well.
You will need to take some combination of medications for the remainder of your life
or your transplanted organ will fail.
All medications have possible side effects.
Here's a list of side effects associated with your transplant medications.
You are not likely to have all of the side effects or have them all at a high intensity.
If you have any concerns about your side affects you should discuss your concerns
with your transplant nurse.
Many of the medications must be tapered or slowly reduced.
Do not independently withdraw from taking any medication.
Discuss any concerns you have with your transplant nurse or physician.
To prevent rejections you will take a combination of three medications after surgery;
prednisone, which is a steroid, azathioprine also known as imuran or mycophenolate also known
as cellcept, tacrolimus for cyclosporine.
The exact combination of these drugs will be determined by the transplant team.
Due to their anti-inflammatory
and immunosuppressive properties steroids have been the main component
in the immunosuppressive regimen for the prevention and treatment
of acute rejection after lung transplantation.
Prolonged exposure to steroids result in significant side effects
which include worsening cholesterol levels and high blood pressure,
the development of post-transplant diabetes mellitus, weight gain, and osteoporosis.
Our standard protocol is designed to minimize these effects
by keeping the maintenance steroid dosage low.
Azathioprine or imuran, mycophenolate, mofetil or cellcept and mycophenolate sodium
or myfortic are medications used in combination with tacrolimus or cyclosporine.
Azathioprine is known to cause liver function abnormalities,
low blood counts, and pancreatitis.
The main toxicities of mycophenolate are upset stomach and diarrhea.
Cyclosporine and tacrolimus can cause abnormal kidney function,
high blood sugar, tremors, and headaches.
These medications could cause serious harm to a fetus if taken while pregnant.
Therefore, women of childbearing ages should avoid pregnancy for the rest of their lives.
If you have any questions regarding these medications or pregnancy,
please discuss it with your transplant coordinator or physician.
Anti-fungal and anti-viral medications are administered
to prevent infection after transplant.
These are very expensive medications,
each one costing approximately two thousand dollars a month.
These medications are usually covered by insurance but carry high co-pays.
Because of the side effects of your transplant medications you may require additional
medications to treat high blood pressure and high blood sugar.
Do not take any non-steroidal anti inflammatory drugs or NSAIDs.
These include Aleve, Advil, Motrin or ibuprofen.
These medications are too *** your kidneys and should be avoided.
Avoid eating grapefruits and drinking grapefruit juice due to numerous interactions
with your transplant medications.
Do not go to the dentist for six months after your transplant operation.
To reduce the risk of developing an infection,
you will need to take an antibiotic before any dental work is done including routine cleanings.
You must learn about each of your new medications before you can be discharged
from the hospital.
You will need to know the drug name, the purpose of the medication, the side effects,
and the dosages of each medication.
The nursing staff will work with you and your caregiver to develop a self-medication schedule.
Your support person must participate in learning about your medications.
To ensure you can safely manage your own medications at home you
and your support person will be quizzed to demonstrate your knowledge
about your medications prior to discharge.
Good nutrition is essential in helping your body heal your incisions
and absorb your anti-rejection medications.
Once the breathing and stomach tubes are removed you will be placed on a liquid diet.
The nurses will gradually advance your diet to solid food.
We expect you to sit up in a chair for all meals after your surgery.
Your nurses will keep track of your intake and output for the first few days after surgery.
This helps the doctors monitor your nutritional status.
You may not feel very hungry after surgery because your senses of taste
and smell are somewhat impaired for a few weeks.
After surgery, healthy eating habits are a vital link to maintaining good physical condition.
Many of your post-transplant medications have side effects
that could negatively impact your heart, liver, kidneys, and your weight.
Following a healthy diet can reduce your risk of complications from high cholesterol,
diabetes, obesity, and infections.
One of our nutritionist will visit you while you're in the hospital
to help you understand what good nutrition
and healthy eating habits look like after your operation.
In general, you will need to follow a low sodium diet for the rest of your life.
Some anti-rejection medicines can cause high blood pressure
by holding sodium and water in your body.
Eating less sodium in your diet can help your body maintain a lower blood pressure.
Your blood pressure is also easier to control if you're not overweight.
Maintaining a healthy weight after transplant is important.
Prednisone can increase hunger and contribute to weight gain.
It can also decrease muscle mass.
That is a powerful combination to combat when you're trying to control your weight.
Your nutritionist will help you understand how many calories are in your diet
and how many you need to control your weight.
The medications used to help your body accept your new lungs can cause your cholesterol levels
to rise.
High cholesterol levels can lead to heart disease.
You will need to follow a low-fat diet to minimize your risk of developing heart disease.
Your nutritionist will help you understand the choices necessary
in building a successful low-fat diet.
Prednisone can also drive the development of diabetes.
You may need insulin to control your blood sugar.
Maintaining a healthy weight will also be helpful
in managing your blood sugar after transplant.
Your nutritionist will spend time reviewing more detailed nutritional guidelines you'll need
to follow in order to stay healthy from now on.
As a newly transplanted patient, you are encouraged to stay in
or around the Ann Arbor area for three months following your operation.
All transplant patients are discharged home with the services of a visiting nurse.
Your nurse will check on you regularly and make sure you're adjusting to your medications.
There are many appointments you'll have to keep in these first three months.
You and your caregivers will need to make many trips to the hospital.
Staying close will help minimize your travel time.
Your first checkup with your pulmonologist is approximately one to two weeks after discharge.
Your first checkup with your surgeon is approximately four weeks after discharge.
The purpose of this visit is to check for any surgical issues, incision healing evaluation,
suture or staple removal, and drainage tube removal if this is still in place.
Removal depends on the amount of output from the drain.
You will have regular appointments
with your pulmonologist every three to four weeks in the beginning.
During those visits you will undergo pulmonary function testing
or PFTs to see how your new lungs are performing.
Bronchoscopy with lung biopsy and cultures will be performed at approximately three weeks,
six weeks, three months, six months,
twelve months after transplant and more often as needed.
You will have a chest x-ray or CT of the chest taken in anticipation
of these surveillance bronchoscopies and as required.
You will need your lab work performed and checked on a weekly basis.
More frequent blood tests can be done at your local lab.
Once you are medically stable and at least six to nine months
out from surgery your pulmonology appointments will be every three months and as needed.
It is important to give your body enough time to heal and adjust
to your new lungs and medications.
Therefore, in the weeks following your discharge
from the hospital there are many restrictions on your activity.
You will not be able to drive a vehicle of any kind car, truck, tractor, riding lawnmower,
motorcycle, golf cart, jet ski, bicycle or scooter
until you are cleared to do so by the transplant team.
You will also need to avoid flying until you are cleared by the transplant team.
Your muscles and bones take longer to heal than your surgical incisions you can see.
Therefore, it is important to follow your lifting restrictions carefully.
You must not lift anything heavier than 10 pounds for six weeks after discharge.
After that, you must not lift anything heavier than 25 pounds for the next six weeks.
It is important that you exercise to regain strength and work your new lungs.
You can attend pulmonary rehabilitation classes, walk outside or on a treadmill,
or ride a stationary bike but you cannot golf, swim, discharge firearms, bowl, play baseball,
basketball, or engage in contact sports until you have been cleared to do so.
To protect yourself from infection, wear a mask for three months while out in crowds.
While these restrictions are temporary, what follows are a list of restrictions
that you must follow for the rest of your life.
To protect your new lungs, you should avoid smoky places
and do not engage in any smoking activities.
As mentioned earlier, you can no longer get any live virus vaccines.
Avoid using tanning beds and always wear sun block when you go outside
to minimize your risk of developing skin cancer.
To avoid certain types of infections, do not keep any reptiles or birds as pets.
You may have a cat but avoid emptying the litter box.
Someone else will have to do if for you.
You must wear a mask at construction sites to avoid dust inhalation.
It is a good idea to keep extra masks with you so you can protect yourself
from changing environmental conditions.
Once your surgical wounds have healed inside and out and many
of your activity restrictions have been lifted it's important
to talk about follow-up care for life.
The University of Michigan Transplant Center team will manage your transplant care for life.
You can return to the care of your family physician for health issues not related
to your lung transplant but before starting any new medications whether prescribed
by your local provider or purchased over the counter,
discuss these with your transplant pulmonologist.
The transplant medications you take are powerful and may enter negatively with other medications.
As mentioned before, it is because of these medications
that our transplant team recommends avoiding pregnancy for life after lung transplant.
Due to transplant medication interactions, birth control pills alone will not be effective
and a second form of birth control is necessary.
The transplant team will work with your care provider to successfully manage your health.
Do I have to take the lungs that are offered to me?
No, but these maybe your only chance at receiving a lung transplant.
Can I live with just one lung?
Yes, you can have normal lung function
and activity tolerance with a single lung transplant.
Can you transplant part of a lung?
The University of Michigan does not perform partial lung
or lobe transplants from living donors.
The surgery was pioneered at the University of Southern California in response
to the shortage of suitable donor organs.
Can a family member donate a lung to a loved one?
No, the University of Michigan only performs lung transplants from deceased donors.
How long will I have to wait on the list?
This is completely dependent upon a suitable donor becoming available.
It can vary significantly from a few days to years.
It is important to understand that a transplant may not happen at all.
Is there anything I can do to get a higher place on the list?
No, your position on the list is determined by your lung allocation score.
Whoever is the sickest goes to the top of the list.
Will I ever be able to stop taking my anti-rejection medicine?
No, you will need to take your medicine everyday for the rest of your life;
otherwise you run the risk of your body rejecting your new lung.
Will I get a beeper while I'm on the wait list?
No, most people have cell phones and no longer have to be tied to their home phone.
However, cell phone coverage becomes less reliable in rural areas so it is important
to be reachable by several numbers.
When can I return to my regular routine?
Students can usually return to their studies in three to six months after surgery.
Returning to work depends on your progress after surgery, as well as the kind of work you.
You will need to consult your transplant pulmonologist for an exact date.
How long will I be under the care of the University of Michigan Transplant Center?
Lung transplant patients require lifelong care at the University of Michigan Transplant Center.
Unfortunately, transplant care cannot be transferred back to your local physician.
However, we will coordinate your care with your doctor
but transplant care will be managed through us.
This concludes our presentation on lung transplantation.
If you have any questions, please contact us at the phone numbers listed on screen.
Thank you for considering lung transplantation at the University of Michigan Transplant Center.
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