Early risks of a lung transplant

95 out of 100 patients will need a blood transfusion within the first week of surgery.

With any operation there is a risk of bleeding. If it happens during the operation, the surgeon can usually stop it with extra stitches or special medications. Patients who take blood-thinning medications (for example, warfarin) have a higher risk of bleeding.

Most lung transplant recipients will require a blood transfusion during or after a transplant. Sometimes, patients who have had a lung transplant will need to go back to the operating theatre for more surgery to stop the bleeding, as well as having a blood transfusion. This is also common.

A blood transfusion carries risks such as fluid overload, production of antibodies, or (very rarely) disease transmission. Your lung transplant team will discuss these with you, and will give you a leaflet that explains these in more detail.

About 70 out of 100 patients will require extra antibiotics for an infection within the first week of lung transplant surgery.

Infections are very common after a lung transplant, in part because you will be given immune suppressing medicines. These medicines reduce the risks of you rejecting your lung, but they will also lower your immune system’s ability to fight infections.

Most infections are treated with a few weeks of antibiotics. Infections can occur in your chest, urine, around the plastic tubes inserted through your skin, or in your surgical wound.

More serious infections can spread to your blood stream. Sometimes, if there is infected fluid around the lung transplant or in the wound, you might need to go back to the operating theatre to have the fluid washed out.

Learn more about the risk of infections

20 out of 100 patients who receive a lung transplant from a deceased donor get primary graft dysfunction. 

Primary graft dysfunction is when a lung fails to function properly after a transplant.

After a lung transplant, it can take a few days, or even a few weeks, for the lung to ‘wake up’ and start working fully. This is called ‘primary graft dysfunction’.

If the lung is not working straight after the transplant, you will require breathing support. This is either through mechanical ventilation or a specialist life support machine called Extra Corporeal Membrane Oxygenation (ECMO). The lung will be scanned to look at its blood supply and the airway to make sure that it is not blocked. The majority of lungs do eventually start working.

What increases the risks of primary graft dysfunction?

• Primary graft dysfunction is more commonly seen in smoking, older, and obese donors. Learn about the risks from a donated lung

• Your risk is also increased if you are having a lung transplant for Pulmonary Hypertension, Pulmonary Fibrosis or are overweight.

The treatment of primary graft dysfunction is largely supportive and may require a long stay in the intensive care unit.

Rejection happens in between 20 to 30 out of 100 patients during the first year after a transplant.

Rejection is when your body’s immune system starts to ‘attack’ your transplanted lung. It happens when your immune system recognises the lung as coming from a different person and thinks it isn’t supposed to be there.

After a lung transplant, patients need to take powerful medicines (‘immunosuppressants’) to help stop rejection happening. Even if you take your anti-rejection medicines carefully, rejection can still occur. This is why your transplant team will closely monitor your health and lung function after your transplant.

Learn more about rejection

This affects 15 out of 100 of patients.

Several nerves around the area of the lung transplant may be damaged. A patch of numbness around the site of the wound is very common but this almost always gets better by itself.

Weakness to the nerve that controls the muscles of the vocal cord is more serious. This may result in a hoarse voice and difficult swallowing. This may be a short-term issue but may continue in some people. It is much less common for it to continue (about one in every 1,000 patients).

The nerves to the swallowing tube (oesophagus) may be damaged and this can result in difficult with eating and drinking. This is also usually short-term for the first two weeks. But rarely can be a long-term issue, which means you will need to feed in a different way. This is usually done by a tube that passes directly into the stomach.

The nerves that control the diaphragm may also be injured during a transplant and may result in a reduced level of function for the lung on that side.

If you have diabetes before the lung transplant, it is likely that your blood sugar will be more difficult to control after the transplant. Your transplant team will help adjust your medications to improve your blood sugar control.

• If you take tablets to control your diabetes before the transplant, it is possible that you will need insulin to control your diabetes after the transplant
• You can help lower the risk of diabetes after a transplant by losing weight and exercising

Between 2 to 3 out of 100 patients experience blood clots inside the transplanted lung.

A blood clot can form within the artery leading to the lung, or the vein draining blood from the lung.

If a blood clot forms within the blood vessels of the lung it can be very difficult to successfully treat.

Some patients are prone to forming blood clots. These patients are at increased risk of blood clots within the lung and are likely to need medication to keep their blood thin after the surgery.

About 1 in 100 patients experience deep vein thrombosis.

Blood clots can form within the deep veins of the leg. These clots can break off and travel in the bloodstream to the lungs, causing lung and heart problems. Blood clots in the deep leg veins are called a deep vein thrombosis (DVT). If they travel to the lung it is called a pulmonary embolus (PE).

How your care team aim to prevent DVT:

• You will be encouraged to get out of bed as soon as you can after a lung transplant to reduce the risk of these blood clots forming.
• Tight stockings help reduce the risk of DVTs and PEs. These should be worn while you are in hospital, and until the transplant team tell you that it is safe to remove them. Some patients should not wear tight stockings, for example if you have major blood flow problems in your leg arteries.
• Blood-thinning medication is usually given to patients after a lung transplant to reduce the risks of DVTs and PEs. However, these blood thinners can increase the risk of bleeding after surgery so a balance needs to be found.

Heart problems affect 1 in 100 patients.

Heart problems can occur soon after the lung transplant. This may be due to a blockage in the blood supply to the heart (‘heart attack’) or problems with the rhythm of the heartbeat.

Lung transplant patients are carefully screened for heart disease before being accepted on to the transplant list. However sometimes these complications may arise it in 1 out of 100 patients.

If your doctor thinks you might be at risk of major heart problems, they’ll test your heart function before you go on the transplant list.

• Even if your heart tests are normal, it is still possible that you may have heart problems after the lung transplant due to the stress of the operation.
• A heart attack happens when there is a blockage in the blood supply to the heart muscle. This usually happens when there is thickening inside the walls of the heart arteries.
• Good treatments are available for both a heart attack, and for problems with the heart rhythm. These treatments include blood thinning medication, or medications to settle the heart rhythm. Sometimes heart doctors (cardiologists) may need to place tubes into the heart arteries to try to unblock them. Sometimes a pacemaker might be needed.

Between 5 to 10 out of 100 patients need further surgery within the first few weeks or months after the lung transplant.

You may need further surgery within the first few weeks or months after the lung transplant.

There are many different reasons why further surgery might be needed, including:

1. Blood collecting in your chest

You will need further surgery if there are large collections of blood in your chest, which cannot be drained by other means.

2. Build up of tissue fluid

Affects 3 to 5 in 100 patients

Tissue fluid can build up around the lung, and this can sometimes push on the lung or the veins around the lung. This can cause the lung to stop working. Sometimes the fluid can become infected. Surgery may be needed, or your lung transplant team may ask the special X-ray team (interventional radiologists) to place a draining tube into the fluid collection.

3. Wound infections, bleeding into the wound or other organ damage

Affects 1 to 2 in 100 patients

Further surgery may be needed due to wound infections, bleeding into the wounds or damage to other organs caused by the transplant surgery.

This happens in between 2 to 4 out of 100 lung transplants.

Sometimes the new lung never starts working. If this happens, your lung transplant team will discuss the options, which sadly are very limited.

There are many reasons why a lung transplant might never work (also called ‘primary non-function’). These reasons include:

• Unknown infection in the donor lung
• A blood clot within the blood vessels that leads to or from the lung transplant that can’t be removed
• Severe early rejection of the lung which is resistant to anti-rejection treatment
• Sometimes it is not possible to know why the lung never worked

This affects fewer than 1 in 100 patients.

A stroke (a blockage of the blood supply to the brain) can happen soon after a transplant. Strokes are more common in older patients, and in those who have had a stroke before.

This might happen in about 1 in every 400 attempted lung transplant operations.

Sometimes the lung transplant operation can start, but the surgeon is unable to finish the lung transplant. This is uncommon.

Reasons include:

• Serious anaesthetic complications that mean it would be dangerous to proceed with surgery (for example, reactions to the anaesthetic or other medications, or serious heart problems)
• Major bleeding that cannot be controlled
• Severe diseases of the arteries or veins that mean that connecting them to the lung transplant is dangerous
• Serious problems with the blood flow within the lung transplant that mean the lung has to be removed during the same operation
• Severe rejection of the lung that cannot be treated during the operation
• New information about the deceased donor or lung that was not available before the operation started (for example, finding a cancer in the donor)

It's important to know that these risks exist, but they are unlikely and the chances of dying during surgery are low.

Fewer than 1 in 1000 patients will get cancer from a donated lung.

It is very rare for cancer to be transmitted with the donated lung. Every effort is made to be sure that a lung donor does not have a cancer that could be passed on to you during a lung transplant. The risk of dying while waiting to receive a lung transplant is much greater than the risk of receiving a lung that has cancer in it.

You may be offered a lung transplant from a donor known to have had cancer. This will only happen if the transplant team think that the risk of the donor’s cancer having spread to the lung is low. You do not have to accept a lung from a donor who has had cancer. This will be discussed in detail with you.

This happens in less than 1 in 1000 patients.

It is rare to get a serious infection such as hepatitis B, hepatitis C or HIV from a lung transplant. It is more common that less serious infections such as cytomegalovirus (CMV) are passed on – this infection is usually easy to diagnose, treat and monitor.

Learn about the risks from a donated lung

Learn more about infections

It is very rare for your lung disease to recur in the transplanted lung.

The average risk of dying during the first few months after a lung transplant is between 10-15 in 100. However, this varies widely on a patient-by-patient basis.

There is a risk of dying during the lung transplant operation, or during the first few weeks or months afterwards. This is usually due to the stress of the surgery on your heart and lungs, or because of serious complications such as infections, heart attacks or strokes.

Each patient has a different risk of dying after the operation. The risk of dying is much higher in older patients. The risk of dying in the first few months after a lung transplant can be as low as 1 out of every 100 patients, or as high as 25 out of every 100 patients.