Healthcare: Transplant Procedures

Lung Transplant Recovery

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Post-Operative Care – Intensive Care Unit

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Immediately after your lung transplant surgery, you will be admitted to the intensive care unit. You will be sedated and have a breathing tube connected to a mechanical device ventilator in place. This is important for the new lung(s) to start functioning and take over the breathing for you.

This phase of recovery involves the intensive care unit (ICU) team, transplant pulmonology, and transplant surgery team working in sync to optimize the immediate post lung transplant care. Apart from the breathing tube, you will have chest tubes to drain fluid from the chest cavity, arterial lines, central nervous catheters to measure heart function and to administer medications and a urinary catheter.

The transplant pulmonology team will generally perform a bronchoscopy for an airway examination and to collect any secretions for testing. Upon determination that your new lung(s) are working well, the ICU team will proceed to remove the breathing tube and allow you to breathe on your own. Time on the ventilator is different for each patient (on average 2-5 days). Occasionally the surgeons will need to perform a tracheostomy (hole in the neck) to remove the breathing tube from your throat to help facilitate weaning you off sedatives and the breathing machine.

Once the breathing tube has been removed, the physical therapy team will start working with you to ambulate. At this stage, the respiratory therapist will teach you deep breathing exercises and ask you to perform incentive spirometry to help expand the newly transplanted lung(s). Your central venous catheters, arterial lines, and Foley catheters will be removed based on daily team assessment. Chest tubes are monitored by transplant surgery team until they are ready to be removed. The ICU stay is generally between 2-7 days.

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Post-Operative Care – Step Down Unit

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The next phase of your recovery continues after you are transferred out from the ICU to the Step-down unit under the close observation of the transplant pulmonology team. The post lung transplant coordinator and pharmacist start post-transplant medication and lifestyle teaching. The aim is to have both you and your caregiver comfortable with your new medication regimen and post-transplant lifestyle.

As your new lung(s) starts to function for you, you will be weaned off oxygen; however, occasionally, some patients will require oxygen. Please talk to your transplant pulmonologist prior to returning your oxygen to your DME. Patients are generally discharged home in 7-21 days following the transplant surgery. Prior to discharge home, you will be given a transplant folder with all the contact information for the transplant team. You have access to the transplant team 24/7, 365 days a year.

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Out-Patient Care

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You are required to stay locally in the Houston area for 3 months post-transplant. This is essential for the lung transplant team to be able to attend to any complications without any delay.

Clinic Visits

You will be seen in the post-transplant clinic every week for the 1st month. Each clinic visit will involve laboratory testing, spirometry, and a chest x-ray prior to the visit with the pulmonologists. After 3 months, you will be seen in the clinic at least once/month until your 1st lung transplant anniversary. Once you are more than 1 year from the transplant, your clinic visits will be less frequent.

Bronchoscopy

All post lung transplant patients undergo routine surveillance bronchoscopy for airway examination, bronchial cultures and transbronchial biopsies to rule out infection and rejection. These are done at 1, 3, 6, 9 and 12 months post-transplant after 1-year bronchoscopies are done based on clinical need. It is recommended that you maintain your relationship with your primary care physician and pulmonologists in addition to your transplant team.

COVID19 and Lung Transplantation

The natural history and progression of COVID19 is still evolving. So far, there have been few reports of lung transplantation for patients with COVID19 related refractory lung failure in the USA, Europe, and China. It is postulated that COVID19 survivors could develop lung fibrosis (scarring) requiring new therapies. Lung transplantation will play an important role in carefully selected patients as a treatment option.

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Outpatient Testing

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Diagnostic Testing
Please note testing is individualized for each patient.

Cardiac Testing

  • Electrocardiogram
  • Two-dimensional echocardiogram
  • Right heart catheterization
  • Left heart catheterization (Age ≥ 40 years)

Imaging

  • Chest radiograph
  • Computed tomogram (CT) chest, abdomen, and pelvis
  • Ventilation-perfusion scan
  • Chest fluoroscopy to assess diaphragmatic function
  • Femoral ultrasonography
  • Carotid doppler (Age ≥ 45 years)
  • Ankle-brachial index (Age ≥ 70 years)

Physiologic Testing

  • Full pulmonary function tests (spirometry, lung volumes, diffusion capacity)
  • 6-minute walk test
  • Arterial blood gas

Upper Gastrointestinal Testing

  • Esophagram
  • pH probe*
  • Esophageal manometry*
  • Esophagogastroduodenoscopy* (EGD)

*If clinically indicated

Laboratory testing

  • Complete blood count with differential
  • Comprehensive metabolic profile
  • Coagulation profile
  • ABO
  • HLA/Tissue Typing
  • Thyroid-stimulating hormone (TSH)
  • Fasting lipid profile
  • Prostate-Specific Antigen (PSA) [Male ≥ 50 years]
  • HgA1C
  • Connective tissue disease lab panel
  • Sputum gram stain, routine, acid fast bacilli and fungal cultures
  • Serum/urine cotinine
  • Toxicology screen
  • Vaccination titers
  • Infectious disease serologies
  • Urine: 24-hour urine collection for creatinine clearance, Urinalysis with Urine culture

Routine Health Maintenance

  • Colonoscopy (Age ≥ 50 years, except Cystic fibrosis ≥ 40 years)
  • Papanicolaou (PAP) smear (Females)
  • Mammogram (Females ≥ 35 years)
  • Dual energy x-ray absorptiometry (DEXA) scan for osteoporosis
  • Dental exam/dental x-rays