How much do you know about the lung transplant process?
James Lee, MD, medical director of the Penn Lung Transplantation Program and Nancy Blumenthal, MSN, CRNP, PhD, director of Clinical Practice and senior nurse practitioner with the Penn Lung Transplant Team, discuss the lung transplantation process, who’s a candidate and the road to recovery.
Lung transplant Q&A
Who is a candidate for a lung transplant?
Dr. Lee: Our job as physicians is to get the full understanding of what's going on with our patient medically. There are many factors that go into assessing the candidacy of a patient to determine whether they are eligible for a transplant such as cardiomyopathy, heart disease, diabetes and obesity. We consider all of these and more with the goal of giving them the best chance of having a long term outcome.
One of the most common diagnoses we see for lung transplants for is emphysema. Emphysema is a very challenging disease in the sense that patients can feel short of breath just walking across the room and it can significantly affect their quality of life. Emphysema at this advanced stage can lead to hospitalization every month with exacerbation or other aggressive therapies. In those cases, I think lung transplant is something to consider.
What are the risks associated with a lung transplant?
Dr. Lee: For everyone undergoing a lung transplant surgery, there are going to be risks involved. When receiving any type of transplant, there is going to be a significant lifestyle change and the possibility for both positive and negative outcomes. There are also side effects from the medications needed to lead to a good, long term outcome. These medications can have both intended side effects as well as unintended side effects. For example, because we're replacing your organs with someone else's, we have to suppress your immune system. These are what we call anti-rejection medicines. Because your immune system is suppressed, you are at risk for infection and will be monitored very closely.
Dr. Blumenthal: Lung transplant outcomes are not perfect. They don't last forever and there is a possibility the lung transplant will fail. We want to be sure that before we encourage a patient to commit to a lung transplant, it will provide a better quality of life for a long period of time.
What is involved in post-transplant care?
Dr. Lee: In my opinion, one of the biggest components is communication. It is the willingness to come in frequently for follow up appointments and undergo procedures and tests that allow us to fully understand what is going on in your post-transplant journey. Whether it be infection or some degree of acute rejection, some complications can be very treatable. If we're aggressive and can deal with these very quickly, the hope is to provide tour patients with the best long term outcome possible.
Dr. Blumenthal: We insist that every patient who goes on the waiting list has support at home because the transition through recovery can be very difficult. Patients are expected to monitor their health and their lung function every single day. Even with the slightest deviation, we expect a call.
Who helps in the recovery process?
Dr. Blumenthal: A physical therapist is part of your care team well before and after your transplant. They will help you get as physically fit as possible and focus on your strength and flexibility. A successful transplant depends not only on what the surgeon does for the patient, but also what shape the patient is in going into the surgery. The physical therapist will often partner with respiratory therapist who will work on pulmonary conditioning, which has more of an aerobic focus.
As part of our evaluation, patients will meet with a dietitian. It is important to fuel your body and muscles before, during and after your transplant. A social worker will be available to help identify resources in your community that may help you throughout the recovery process. We usually recommend a pulmonary rehab program, which is a specialized exercise program present in every community.
What sets Penn apart?
Dr. Lee: We have a goal as a group to provide the best quality, patient focused care that we can and we take it very seriously. What I like to convey to my patients is that we are very collegial, close-knit group of clinicians, researchers and nurse practitioners. We are very focused on doing our best to diagnose your disease and give you the best treatment options available. We want to find appropriate treatments for you, answer all of your questions and if we're in tough situation, we think outside the box. As a large institution, we have access to clinical trials, trials that have to be done to help change and advance our field of medicine.
Dr. Blumenthal: Penn completed their first lung transplant in 1991, and in the 24 years of caring for our patients, we've done nearly 1,000. While there is no one on our team who has had a lung transplant themselves, and we're not in our patients shoes, we've walked alongside them and have faced many challenges along the way. Our goal is to find a solution to these challenges while providing our patients with a lot of support.