After the surgery, you will be taken to the intensive care unit or ICU. You will remain there until you can breathe without the help of the ventilator, or breathing machine, and until your condition is stable. In the ICU, you will be on a monitor that shows your heart rate, blood pressure, and other vital signs to the team at all times. The endotracheal or “breathing” tube, intravenous, chest tubes, nasogastric tube, and urinary catheter will be removed as your condition improves.
If you still require the ventilator to breathe after about a week, you may need to have a temporary tracheostomy tube inserted through your neck into your trachea. The tracheostomy will make you feel more comfortable and help you to get strong enough to breathe without the ventilator and will make it easier to clear mucus from your lungs. The staff will be able to suction the mucus from your lungs through the endotracheal or tracheostomy tubes.
While on the ventilator you will not be able to talk, but if you are awake enough, you will be able to communicate by mouthing words, writing, or using other devices. Once you are well enough to leave the ICU, you will be moved to the acute care unit or ACU, and then to the regular care unit. Most people stay in the hospital for about fifteen days to four weeks after receiving a lung transplant, while others may have to stay longer. You will be given anti-rejection and anti-infection medications to ensure that your lungs work well.
You will also receive medications for other conditions that you might have, such as pain. Pain should improve over time and pain control is a priority because you must participate in physiotherapy after the transplant to gain strength and avoid other complications. You will be sitting in the chair and walking as soon as possible after the surgery with the help of the physiotherapists and nurses. The team will help you to get home or to a rehabilitation hospital as soon as it is safe. The team includes doctors, pharmacists, dieticians, speech therapists, physiotherapists, nurses, and social workers.
Discharge from the Hospital
As you recover from your transplant, we will help you to learn how to monitor your health and to understand complications that may occur. After the transplant, you will have weekly clinic visits at the transplant clinic for the first few months and then less frequent visits over time. Your caregiver must attend all your clinic visits. Before each clinic visit, you must have blood work, a chest x-ray, and a pulmonary function test. Bronchoscopies will be frequent in the first few weeks and CT scans of the chest will also be done at longer intervals. You will participate in an exercise program three times a week for the first three months after your discharge. The physiotherapy team will monitor your physical progress and develop an exercise program with you. Ongoing exercise is recommended after completion of your supervised program.
REJECTION AND INFECTION POST-TRANSPLANT
Two of the most common complications following the transplant are the rejection of the lung and infections. Rejection is common and can happen any time after your transplant. Rejection happens because your immune system attacks your transplanted lungs. Your immune system sees your new lungs as invading cells and can damage them. To prevent this, you will take anti-rejection medications, also called immunosuppression medications. You will need to take these medications every day for the rest of your life to protect your new lungs.
Despite taking anti-rejection medications, rejection can still occur. It is often reversible as long as it detected and treated quickly. If the rejection is detected your treatment plan may include additional medications, adjusting your current medications, and other treatments. Unfortunately, immunosuppressive medications also decrease the body’s ability to fight infection, and infections of the lungs are very common. Your weekly clinic visits will allow the transplant team to monitor for rejection and infection.
You will also need to:
• Perform home spirometry readings every day and keep a record of your reading.
• Learn the signs and symptoms of rejections and infections and report any unusual symptoms to your transplant team right away.
The transplant team will continue to monitor your health and will work closely with you, your caregiver person, your family doctor/ general physician, and your pulmonologist for the rest of your life. Your family doctor will continue to help you to maintain your general health and well-being. You will be assigned a transplant nurse coordinator and physician whom you and your caregiver can communicate with. Your team is there to help you, but it is important that you play an active role in maintaining your health and keep them informed about changes.
Recognizing the Donor Lung as “Different”
Your body's natural immune cells can recognize small, unique proteins called "antigens" that are present on the surface of all cells or infectious particles. These immune cells, called the T cells and the B cells, can recognize the antigens as "self" if they belong to you or "non-self" if they do not belong to you (such as those in the donor lung). This recognition occurs mainly through complex proteins on the cell surface called HLA antigens. The HLA system is made up of three classes with many subtypes, each person has a combination of these HLA proteins that makes him or her unique like a thumbprint, a signature. The differences in these signatures help our immune cells to separate "self" from "non-self”. They then direct an attack on the foreign donor lung, resulting in "rejection".