Thanks to medical advances and the close care provided by the specialized multidisciplinary team, survival after lung transplantation at our center is above average compared to the international average.
Five years after lung transplantation, more than 70% of patients are still alive. Despite the lifelong intake of various medications, some of which have many side effects, the significantly better quality of life after lung transplantation is also remarkable.
Indication and contraindication
Lung transplantation offers a treatment option for patients suffering from severe advanced lung disease that cannot be improved despite optimal medical or surgical treatment. The disease is usually so severe that both the quality of life is severely restricted and life expectancy is reduced.
Various lung diseases can be treated with a lung transplant:
- Diseases of the bronchial tubes such as cystic fibrosis or severe bronchiectasis affecting the entire lung.
- Chronic obstructive pulmonary disease (COPD), which typically includes emphysema due to nicotine abuse or emphysema due to congenital alpha-1-antitrypsin deficiency.
- Interstitial lung diseases such as idiopathic pulmonary fibrosis or sarcoidosis.
- Pulmonary arterial hypertension.
- Rare lung diseases such as lymphangioleiomyomatosis or histiocytosis.
The following diseases do not allow treatment by transplantation:
All patients suffering from active cancer (e.g. of the lungs) but also serious untreatable diseases of other organs such as the heart and liver.
- General medical examinations
- Exclusion of possible contraindications
- Exclusion of a possible infection situation
- Exclusion of a tumor
- Immunological clarifications and tissue typing
- Clarification of the psycho-social situation and compliance
The necessary clarifications are carried out as part of a hospitalization at the University Hospital Zurich.
Once all clarifications have been completed, the members of the Lung Colloquium discuss whether a patient can be placed on the waiting list. The patient is then formally placed on the national lung transplant waiting list. The timing of the lung transplant cannot be predicted and the waiting time can vary depending on the recipient’s blood group. The donor organs are provided by deceased organ donors. In Switzerland, these are registered via Swisstransplant and allocated from there in accordance with the applicable guidelines.
Once they are on the waiting list, patients must expect to be called to the hospital for a transplant at any time. For this reason, they must always be available.
During the time on the waiting list, patients are closely monitored by the lung transplant team at the Clinic for Pneumology.
What happens during the transplant?
Before the operation
As soon as a suitable donor lung is available, the transplant coordination team contacts the patient and organizes transport to the hospital as quickly as possible.
On admission to the hospital, the patient’s state of health since the last check-up is checked, a few tests such as a blood sample and ECG are repeated and the necessary medication for the transplant is administered.
During the operation
In most cases, we replace both lungs during transplantation. This is done by making a cut along the 4. or 5th rib from the sternum towards the armpit.
In about half of the patients, a heart-lung machine must be used during anaesthesia to stabilize circulation and ventilation. The operation takes approx. 6 – 10 hours.
After the operation (early hospitalization)
After the operation, the patient is stabilized in the intensive care unit. The aim is for the patient to be weaned off the ventilator after just one day. If everything goes well, he can be transferred to the general ward after just 1 – 2 days. The aim is to help the person concerned to lead as natural and independent a life as possible, quickly but adapted to the situation.
After the operation (late hospital stay)
In the transplant ward, the various drainage tubes and lines are removed after a few days. The aim is for the patient to be mobilized early and to eat normally.
The first one to two weeks can be difficult, as the severely weakened body must first recover from the operation and various medications must be taken. Pain management plays a particularly important role in the first few days. The coordinators of the lung transplant team train the patient together with the nurses in the department on how to take the medication and give tips and instructions for life after the transplant.
Do I have to take medication?
After the transplant, the patient must take lifelong medication that influences the immune system to prevent rejection of the lung. These immunosuppressants result in an increased risk of infection.
Therefore, various medications against infections must be taken in the first few weeks. The medication levels in the blood are checked and optimally adjusted for each patient.
How will the recipient be looked after?
After discharge from hospital, a follow-up check is carried out in the lung transplant consultation. This is where the clinical course, blood values and medication dosage are checked and monitored.
During the first 6 months, the immunosuppressive medication is slowly reduced, which means that the anti-infective medication can also be reduced.
Especially in the first 6 months, it is important that the slightest signs of rejection or infection are recognized as quickly as possible and that appropriate treatment is initiated. Follow-up checks are carried out at increasingly longer intervals over time, but continuous care remains necessary.
Life after the transplant?
After a lung transplant, patients can lead an almost normal life again. Physical fitness allows the patient to return to work, hobbies, sports and social and intimate activities as in a normal life.
The most important restriction is the regular and disciplined intake of medication and the rapid response to signs of illness in close contact with the doctors in the lung transplant team.
What are the results?
The majority of patients experience a dramatic improvement in quality of life and an improved chance of survival.
The chances of survival after one year are around 90% and after five years over 75%. This of course depends on the risk profile.
The survival rate after lung transplantation at the University Hospital Zurich is around 90% in the first year and around 75% after five years. This depends largely on the underlying disease.