Longer-term risks of a lung transplant

Infections are very common, even many months or years after a lung transplant.

The most common infections are chest or urine infections. These are usually fairly straightforward to treat with antibiotic tablets.

Some infections come from the donor lung. The most common of these is a virus called CMV (cytomegalovirus). This virus infects more than half of healthy people and, after the initial infection, remains dormant in the body for the rest of your life.

Learn more about the risk of infections

Learn the risks from the donated lung

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

The risk of rejection is highest in the first 3-6 months after a transplant. After this time, your body’s immune system is less likely to recognise the lung as coming from another person. Even if you take your anti-rejection medicines, rejection can still occur. This is why it’s important to keep your appointments in clinic, and take the tablets that have been prescribed for you.

Learn more about rejection

This affects between 1 to 10 out of 100 patients.

Narrowing (stenosis) of the lung transplant airway may arise in some patients. This usually causes wheeziness and breathlessness. It is suspected if your lung function gets worse for no other obvious reason. Scans of the chest help to demonstrate if there is any narrowing in the airway. Fibreoptic bronchoscopy can demonstrate the problem and attempt at stretching the airway from inside may help. This has some risks (for example, it may cause bleeding, or may damage the arteries). Your lung transplant team will discuss this with you.

The transplant team may recommend leaving a small tube inside the airway to keep the narrowed area open (this is called a stent). The stent may help the narrowing of the airway but may result in other long-term problems, such as bleeding, infection and breaking up of the stent.

This affects fewer than 1 in 100 patients.

A stroke (a blockage of the blood supply to the brain) can occur many months or years after transplant. It is important to stop smoking, take regular exercise, keep a healthy body weight, and have good blood sugar and blood pressure control. Doing these things will reduce the risk of a stroke. Strokes are more common in older patients and in those who have had a stroke before.

There is a higher risk of some types of cancer following a transplant.

There is a higher risk of some types of cancer following a transplant. Skin cancers are particularly common in lung transplant patients. Other cancers, such as lymphomas, are also more common in lung transplant patients. If you notice a lump, something unusual on your skin or anything else that you’re worried about, please let the transplant team know.

What you can do:

• Avoid staying out in the sun for long periods, and wear factor 50 sunblock and a long-sleeved shirt and a hat if you are in the sun.
• It is strongly recommended that you attend any cancer screening tests, such as a mammogram, cervical smear or bowel cancer screening.
• If you notice a lump, something unusual on your skin or anything else that you’re worried about, please let your transplant team know.

Recurrent disease is when your original lung disease comes back and damages your new lung.

It is possible for your original lung disease to come back in your new lung (‘recurrent disease’). This chance of this happening is very rare but can depend on the cause of your lung disease.

For some diseases this is more common, for others extremely rare. Your lung transplant team will tell you whether your lung disease is likely to come back and damage your lung transplant.

You will need to take powerful medicines after a lung transplant.

You may experience side effects to your transplant medicines. Different lung transplant centres use different medications to prevent rejection and infection in their patients. Your own transplant centre will tell you about the medicines they will prescribe after your transplant, and the most common and most important side effects that you need to know about.

In general, medicines for lung transplant patients include:

Immunosuppressants

To reduce the risk of lung rejection.

The doses of these medicines reduce over time, but some medicines will be needed for the lifetime of the lung transplant. All immunosuppressants increase the risk of infection, and of some cancers.

Antibiotic and antiviral medicines

To reduce the risk of infection.

These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

• Medicines to lower blood pressure, reduce blood sugar levels, or reduce the risk of blood clots. 
• Medicines to protect the lining of your stomach, as some immunosuppressants and blood thinners can cause stomach irritation 
• Medicines to protect your bones
• Medication that you may need for other health issues

Learn more about medications after a lung transplant

Heart problems can happen many months or years after the lung transplant operation.

These problems may be due to a blockage in the blood supply to the heart. This is called a heart attack. A heart attack happens when there is a blockage in the blood supply to the heart muscle. This usually happens when there is thickening of the walls of the heart arteries.

Good treatments are available for a heart attack. These include blood thinning medication and medication to improve the blood flow to the heart muscle. Sometimes heart specialists (cardiologists) may need to place tubes into the heart arteries through blood vessels in your groin, wrist or elbow in order to inspect the heart arteries and try to unblock them.

What you can do to reduce the risk of a heart attack:

• Don't go back to smoking after a transplant
• Take regular exercise
• Keep a healthy body weight
• Maintain healthy blood sugars and blood pressure

Sadly, between 5 to 7 in every 100 patients will die each year after a lung transplant.

There is a risk of dying following the transplant. This risk is highest in the first few weeks or months after the operation. Once you have recovered from the physical stress of the operation, there are still risks of heart attacks, strokes, infections, and cancers.

It is important to remember that your transplant team won’t recommend that you have a lung transplant if they believe that the risk of the operation is higher than the benefits. For most patients, the risk of dying after the transplant is lower than the risk posed by their original lung disease.

The risk of dying is different for different patients. The risk is higher in older patients, and in those who have serious heart, lung, blood vessel or liver disease and those who have previously had cancer or major infections. If your lung transplant team think that you have a higher than average risk of dying following a lung transplant, they will talk to you about this.