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UofL Health

Lung Transplant

For more than 15 years, our lung transplant program has given new hope to people of all ages. We perform lung transplants for the entire spectrum of respiratory diseases.

The first heart/lung transplant in Kentucky was performed in 1988 at UofL Health – Jewish Hospital, and the first double-lung transplant was performed in 1995. Patients dealing with end-stage lung disease have continually relied on the expertise of our multi-disciplinary team of transplant surgeons, pulmonologists, transplant coordinators, psychiatrists, social workers, financial coordinators, medical consultants and administrators who work closely with the operating room, critical care and medical-surgical units at UofL Health – Jewish Hospital to provide the highest standard of patient care.

When lung transplant becomes your next step, we are here to help you in your journey to breathing easier again.

Start here to learn more about different stages of lung transplant:

  • Consultation & Evaluation
  • Preparing and Waiting for Transplant
  • The Transplant
  • Life After Transplant

Consultation & Evaluation

Initial Consultation

During your first appointment, you will meet with the lung transplant coordinator and a pulmonologist. Once your medical history is reviewed, you will receive information regarding transplant, potential risks and benefits of having a transplant and an overview of the evaluation process. While not required, many patients find it helpful to bring someone with them to the initial consultation.

* It is important that you have enough oxygen to last several hours for the consultation

In 1-2 weeks, the lung transplant coordinator will contact you to let you know if the transplant team thinks you are an appropriate candidate for transplant evaluation and to determine if you are interested in pursuing one. If you are interested, an evaluation will be scheduled.

Transplant Evaluation

The lung transplant evaluation consists of three days of testing, education, consultations and meetings with different members of the lung transplant team. A typical evaluation is done on a Monday, Tuesday and Wednesday. Once your evaluation is scheduled, we will mail a packet with your personalized schedule and directions for the tests. Please open this packet upon receipt and review prior to your evaluation.

Day 1 – Labs and Testing

On this testing day, you will be moving from department to department, and most patients bring someone along to help assist them if needed. You will need to have enough oxygen with you to last the whole day.

Tests may include:

  • VQ scan (ventilation/perfusion lung scan)
  • Chest CT scan
  • Six-minute walk
  • EKG (electrocardiogram)
  • Abdominal, neck and leg ultrasounds
  • Bone density scan
  • Pulmonary function test
  • Echocardiogram
  • Blood work
  • Urine collection

Day 2 – Consults/Appointments

Appointments will include:

  • Pulmonary rehab: An evaluation of your physical abilities and oxygen needs. This will include one or more six-minute walk tests in which you will need to provide your own oxygen. Please bring shoes that are comfortable for walking
  • Transplant education: One of the transplant coordinators will educate you about pre- and post-transplant life. This is an opportunity to learn and ask questions. We recommend bringing someone from your support team to this appointment.
  • Social worker: A social worker will complete a psychosocial evaluation to help develop a plan to get through the whole process. Any barriers to transplant will be discussed with patients. We recommend bringing someone from your support team to this appointment.
  • Registered dietitian: An evaluation of your current diet to help you set appropriate goals for a healthy lifestyle.

Day 3 – Heart Catheterizations

Heart catheterizations will be performed to assess your heart. These are typically done as an outpatient procedure. You will need someone to drive you home following the procedure. 

Preparing and Waiting for Transplant

All patients are listed through the United Network of Organ Sharing (UNOS). When a patient is listed for lung transplant, they are given a Lung Allocation Score (LAS). This score ranges from 0-100 and is a relative indicator of the urgency with which a patient needs a transplant based on the testing that is done during the evaluation process.

While patients are listed for lung transplant, they will be seen in our office at least once every three months for assessment and management of their transplant status. Patients will need to continue to follow up with their referring pulmonologist for management of their lung disease.

Your LAS is updated at a minimum of every six months with new testing but may need to be updated more often based on your condition. It is very important to keep in contact with the lung transplant coordinator regarding your condition and any changes in health or medications.

Pulmonary rehab is required the entire time while someone is on the lung transplant wait list and for a minimum of one year following the transplant.

The Transplant

Lung transplants take 6-8 hours, and you will be monitored for several more hours after surgery in the operating room before moving to the cardiovascular intensive care unit (CVICU). If you are getting a single lung, the incision will be across your side and around the back of the chest. For a double lung transplant, the incision is typically done under the breast line, from armpit to armpit. Your family will be updated periodically during the procedure to let them know how you are doing.

In the CVICU

Once you are taken back to the CVICU, you will have many lines and tubes in place. You may have IV medications to help with blood pressure control; you may require blood products and special medications to lower your immune system. You will have up to four chest tubes – two on each side of your chest for double lung transplants and two on the transplanted side for single lung transplant. The average time a patient spends on a breathing machine varies, but the average time following a lung transplant is three days. Once you are breathing on your own and the breathing tube has been removed, you will be required to participate in aggressive physical therapy to lower the risk of getting pneumonia in your new lung(s), which could make you very sick and extend your hospital stay.

The transplant surgeon will update your family following the surgery. Your family will be allowed to see you as soon as you are stable in the CVICU. The CVICU has open visitation hours with the exception of 6:30 – 8:30 a.m. and p.m.

After the CVICU

Once your transplant team decides you no longer require intensive care, you will be transitioned to a “step-down” unit for intermediate level care. Our nurses in the step-down unit have specialized training in caring for lung transplant recipients. You will continue to participate in physical therapy and go to Frazier Rehab Institute on the UofL Health – Jewish Hospital medical campus for pulmonary rehab to help teach you how to breathe with your new lung(s).

Life After Transplant

Once you are discharged from the hospital, your appointments with the transplant center will continue. Follow-up appointments will include:

  • Clinic visits: Weekly clinic visits, blood work and testing will occur for the first 1-2 months in order to closely monitor your progress
  • Blood work: For the rest of your life on a monthly basis, you will have monthly lab work. This is done to properly adjust your anti-rejection medications and monitor how your other organs are reacting to your anti-rejection medications. We also recheck your blood one week after any medication changes.
  • Surveillance bronchoscopy and lung biopsy: Bronchoscopies and lung biopsies are a way the transplant team monitors your new lung(s) for infection and organ rejection. These are typically performed at two weeks and four weeks post-transplant and at months two, three, six, nine and twelve. These are outpatient procedures usually done on Wednesdays, followed by clinic visits on Thursdays. Keeping these appointments are critical.
  • Pulmonary rehab: Required for at least the first 12 months following lung transplantation.
  • Education: The transplant coordinator, social worker and dietitian will continue to evaluate your progress and help you adjust.

Following your discharge, you could have anywhere from 10-15 medications. Some are anti-rejection medications; others are medications to prevent infections. It is very important to take medications exactly as you are instructed.

Please call 502-587-4384 to speak with our lung transplant coordinator.

Patient Story 

Zack B. – Double Lung Transplant

“I’ve been given an opportunity to be alive again,” said Zack. “I want to share that same chance with others and help raise funds for UofL Health – Jewish Hospital, for organ donation and for cystic fibrosis research and treatment. It’s critical to give other people the same opportunity that I have been given.”