A lung transplant is a complex operation and the risk of complications is high.
Some complications are related to the operation itself. Others are a result of the immunosuppressive medication which is needed to prevent your body rejecting the new lungs.
Some of the complications are discussed below.
Reimplantation response is a common complication affecting almost all people with a lung transplant. The effects of surgery and the interruption to the blood supply cause the lungs to fill with fluid.
The symptoms are usually at their worst 5 days after the transplant. These problems will gradually improve, and most people are free of symptoms by 10 days after their transplant.
Rejection is a normal reaction of the body. When a new organ is transplanted, your body's immune system treats it as a threat and produces antibodies against it, which can stop it working properly. Most people experience rejection, usually during the first 3 months after the transplant.
Shortness of breath, fatigue (extreme tiredness), and a dry cough are all symptoms of rejection, although mild cases may not always cause symptoms.
Acute rejection usually responds well to treatment with steroid medication.
Bronchiolitis obliterans syndrome
Bronchiolitis obliterans syndrome (BOS) is another form of rejection that typically occurs in the first year after the transplant, but could occur up to a decade later.
In BOS, the immune system causes the airways inside the lungs to become inflamed, which blocks the flow of oxygen through the lungs.
- shortness of breath
- dry cough
BOS may be treated with additional immunosuppressant medications.
Post-transplantation lymphoproliferative disorder
After having a lung transplant, your risk of developing a lymphoma (usually a non-Hodgkin lymphoma) is increased. This is known as post-transplantation lymphoproliferative disorder (PTLD).
PTLD occurs when a viral infection (usually the Epstein-Barr virus) develops as a result of the immunosuppressants that are used to stop your body rejecting the new organ.
PTLD affects around 1 in 20 people who have a lung transplant. Most cases occur within the first year of the transplant. It can usually be treated by reducing or withdrawing immunosuppressant therapy.
The risk of infection for people who've received a lung transplant is higher than average for a number of reasons, including:
- immunosuppressants weaken the immune system, which means an infection is more likely to take hold and a minor infection is more likely to progress to a major infection
- people often have an impaired cough reflex after a transplant, which means they're unable to clear mucus from their lungs, providing the perfect environment for infection
- surgery can damage the lymphatic system, which usually protects against infection
- people may be resistant to one or more antibiotics as a consequence of their condition, particularly those with cystic fibrosis
Common infections after a transplant include:
- bacterial or viral pneumonia
- cytomegalovirus (CMV)
- aspergillosis – a type of fungal infection caused by spores
Long-term use of immunosuppressants
Taking immunosuppressant medications is necessary following any type of transplant, although they do increase your risk of developing other health conditions.
These health conditions are described below.
Kidney disease is a common long-term complication. It's estimated that 1 in 4 people who receive a lung transplant will develop some degree of kidney disease a year after the transplant.
About 1 in 14 people will experience kidney failure within a year of their transplant, rising to 1 in 10 after 5 years.
Diabetes, specifically type 2 diabetes, develops in around 1 in 4 people a year after the transplant.
Diabetes is treated using a combination of:
- lifestyle changes, such as taking regular exercise
- medication, such as metformin or injections of insulin
High blood pressure
High blood pressure develops in around half of all people a year after a lung transplant and in 8 out of 10 people after 5 years.
High blood pressure can develop due to a side effect of immunosuppressants or as a complication of kidney disease.
Like diabetes, high blood pressure is treated using a combination of lifestyle changes and medication.
Osteoporosis (weakening of the bones) usually arises as a side-effect of immunosuppressant use.
Treatment options for osteoporosis include vitamin D supplements (which help strengthen bones) and a type of medication known as bisphosphonates, which help maintain bone density.
People who have received a lung transplant have an increased risk of developing cancer at a later date. This would usually be one of the following:
Because of this increased risk, regular check-ups for these sorts of cancers may be recommended.