Lung transplantation can prolong and dramatically improve the quality of life for patients with advanced lung diseases. The Center for Advanced Lung Disease and Lung Transplantation at NewYork-Presbyterian/Columbia University Irving Medical Center is one of the oldest and largest in the United States, with decades of lung and heart-lung transplantation experience and expertise.
Our lung transplant physicians and surgeons have performed more than 1,600 lung and heart-lung transplants since 1988, and more than 1,400 transplants have been performed since 2001, when new program leadership was launched.
Our lung transplant program takes on the highest-risk cases that are often declined as too high risk at other transplant centers. Despite accepting the highest-risk transplant candidates, our short-term survival is comparable with the national average, and we have significantly longer 5- and 10-year survival compared to the national average. Over the years, we have earned a reputation for our clinical expertise and rigorous commitment to excellence, working to improve lung allocation policies, expand the pool of donor lungs, and bridge critically ill patients with respiratory failure to lung transplants through innovative technologies.
Celebrating the 1500th lung transplant at NewYork-Presbyterian.
What is a Lung Transplant?
What is a Lung Transplant?A lung transplant is a surgical procedure to replace a patient’s diseased lung(s) with healthy donated lung(s) from another individual. It is considered for patients with advanced lung diseases who have not responded to other treatments and face a limited life expectancy without the transplant.
What Conditions are Treated by a Lung Transplant?
Conditions TreatedA lung transplant is used to treat conditions where the lungs cannot properly function, causing oxygen deficiency, carbon dioxide build-up, and/or right heart failure. In extreme stages, this results in respiratory failure, requiring support from a ventilator or other advanced heart and lung support devices. The conditions that require a lung transplant include:
- Interstitial lung disease and pulmonary fibrosis (inflammation and scarring of the lungs)
- Chronic obstructive pulmonary disease (COPD) and emphysema
- Pulmonary hypertension (high blood pressure in the lungs)
- Sarcoidosis
- Scleroderma, rheumatoid arthritis, and other autoimmune lung diseases
- Advanced lung disease due to cystic fibrosis (CF)
- Other diseases or hereditary conditions that can affect the lungs, such as Langerhans Cell Histiocytosis, COVID-19 pulmonary fibrosis, and Lymphangioleiomyomatosis (LAM)
How is a Lung Transplant Performed?
ProcedureA lung transplant is a major surgery that can take 6 to 8 hours to perform and requires a stay in the hospital. The procedure involves replacing the diseased lungs with healthy donor lungs.
The lung transplant surgery involves the following steps:
- General anesthesia is administered through a breathing tube that is placed down the patients throat to ventilate the lungs so the patient can breathe and doesn’t feel any pain
- A lung transplant surgeon makes an incision in the chest
- A cardiopulmonary bypass or ECMO machine may be used, if needed, to keep blood circulating during the operation
- The chest is opened, the transplant surgery team removes the old lung(s) and connects the main airways and blood vessels between the new lung(s) and the heart
- If a heart-lung transplant surgery is being performed, the transplant team will remove the heart and lungs and replace them with new ones
- The transplant team will close the chest, and the bypass machine is removed when the new lung(s) start working adequately to support the body
- The breathing tube is removed once the new lung(s) are functioning adequately
- Special drainage tubes will be left in the chest for several days to remove the build-up of fluid or air while the lungs are healing
- Once the patient is breathing and the lungs are functioning adequately, tubes are removed, and the patient is moved to a hospital room in the transplant unit
Risks to Consider
Risks to ConsiderA lung transplant is considered a major surgery, and as with any major surgery, there could be side effects or complications. The risks associated with a lung transplant vary depending on the overall health of the patient and include:
- Rejection of the Transplanted Lung
- Bleeding
- Infections
- Blood clots
- Medication Side Effects, including:
- Hypertension
- High cholesterol
- Osteoporosis
- Kidney dysfunction
- Increased risk of cancer
Due to the risks involved, lung transplantation is not the best option for every patient with severe lung disease. All of these risks and potential complications will be reviewed by your doctor and coordinator during the initial introduction and evaluation period and before listing.
Preparing for a Lung Transplant
Preparing for a Lung TransplantPreparing for a lung transplant is lengthy and typically begins months before the transplant is done. The process starts with a complete medical history and physical examination by the transplant team, including diagnostic tests, blood work, and psychosocial evaluation. The goal of testing is to ascertain if patients will do well after a lung transplant or to determine if they have any serious medical issues that will make it unlikely for them to benefit from lung transplantation.
- Blood tests. Blood tests are required to help match the patient with a donor as well as to assess the function of many other organs and past infections.
- Diagnostic tests. Multiple diagnostic tests are performed to determine the overall health of the patient, such as X-rays, CT scans, ultrasound, pulmonary function tests, heart testing, and healthcare maintenance assessments, such as eye, dental, mammogram, PAP smear, and others.
- Psychological and social support evaluation. A patient’s psychological and social environment can have a major impact on the outcome of a lung transplant. Patients are evaluated for stress, depression and anxiety, their healthcare literacy and insight, support from family and friends, and their health insurance to ensure proper coverage for medical care and medications.
Other criteria and requirements that must be met prior to a lung transplant:
- No smoking or nicotine use. Patients approved for a lung transplant must be nicotine-free for at least six months to qualify for transplant listing.
- No active drug or alcohol use for at least six months.
- Immunizations. A list of several immunizations that need to be administered to decrease the chances of infection post-transplant will be provided.
What to Expect After a Lung Transplant
After the TransplantIntensive care and hospital stay
- Intensive care unit (ICU). Most patients should expect to stay in the intensive care unit for two to seven days. A ventilator connected to a breathing tube will assist with breathing, and a special heart-lung pump, such as ECMO, may be used to support the new lung(s) in the initial days of the transplant. Tubes in the chest will drain excess fluid and air from around the heart and lungs. Antirejection and antibiotic medications will be administered to prevent rejection of the new lung(s) and infections. Pain will be controlled with medications. As the patient progresses, the breathing tube is removed, and the patient is moved to a hospital room in a dedicated transplant unit.
- Hospital. The average time for most patients to stay in the hospital after leaving the ICU is 14 to 28 days. This can vary depending on the patient's overall health and progress after surgery.
At-home recovery
- Your doctor will provide specific at-home instructions to help prevent infection and rejection.
- Monitoring of medications and side effects to avoid organ rejection and infection. Signs of rejection can include shortness of breath, congestion, coughing, or fever. Antibiotics, antiviral, and/or antifungal medications will also be prescribed.
- Frequent, once weekly follow-up appointments with your transplant team and doctor for the first three months will be required to monitor your progress and lung function.
- Various tests will be required during follow-up appointments to monitor progress. Tests include blood work, chest X-ray, lung functions tests, bronchoscopy, electrocardiogram (ECG), and other laboratory tests.
- The recovery process for a lung transplant patient can take up to three to six months depending on the overall health of the patient.
Lifelong and follow-up support
- Exceptional survival rates. The long-term survival rates for our lung transplant recipients remain above the national average. Since the inception of the new transplant team in 2001, we have performed more than 1,600 operations with a one-year patient survival of about 90 percent and long-term survival that significantly outperforms the national average. We have a five-year patient survival of 65 percent and ten-year survival of 36 percent. Transplant recipients at our center have a 26% improved survival compared to the national average. The NewYork-Presbyterian Lung transplant program is one of the largest transplant programs in the United States and accepts very high-risk cases, including cases that were previously declined at other transplant programs.
- Lifelong follow-up and support. Transplantation is a life-altering procedure. Patients need life-long immunosuppressant medications and very careful monitoring indefinitely. Throughout the transplant process and beyond, we partner closely with recipients and their referring physicians to achieve a seamless continuum of care while helping patients and their families navigate any medical, emotional, financial, and logistical concerns they may have. Our transplant team is here for our patients – for life.
Receive a Lung Transplant at NewYork-Presbyterian
Patients travel across the country and the globe to receive care from the lung transplant team of experts at NewYork-Presbyterian Hospital. As one of the top lung transplant programs in North America, we treat some of the most complex cases that other transplant centers are not equipped for.
If you or a family member has advanced lung disease, please call to schedule an appointment with one of our NewYork-Presbyterian lung transplant specialists to learn more about what specific treatment options, including lung transplantation, may be available to you.