Lung Transplantation Turkey

What is a Lung Transplant?

A lung transplant involves taking a healthy lung and transplanting it into a person whose lung is no longer functioning. It is done for individuals who are unable to regain their health through other treatment methods.

Is a Lung Transplant Possible?

Yes, a lung transplant is possible. The first lung transplant in the world was performed in 1963, and the first successful transplant took place in 1983 in Toronto, Canada. It is considered the most challenging of all organ transplants.

Lung Transplantation in Turkey

The first successful lung transplant in Turkey was performed in 2009. Since 2012, the number of lung transplants in Turkey has been increasing. Currently, Ankara City Hospital, Kartal Koşuyolu High Specialization Training and Research Hospital, and Ege University Medical Faculty are among the centers that perform lung transplants in Turkey.

Who is Eligible for a Lung Transplant?

Lung transplants are performed in cases of end-stage lung disease. Some of the most common conditions that may require a lung transplant include:

• Chronic Obstructive Pulmonary Disease (COPD): The most common disease group for lung transplants.
• Idiopathic Pulmonary Fibrosis (Pulmonary scarring).
• Cystic Fibrosis.
• Pulmonary Arterial Hypertension (Pulmonary hypertension).
• Rheumatic and connective tissue diseases (Systemic Sclerosis, Rheumatoid Arthritis).

Who is Not Eligible for a Lung Transplant?

Not every patient considered for a lung transplant is suitable for the procedure. Lung transplantation is a complex and challenging treatment. Therefore, patients must be evaluated for additional complications and conditions that may prevent the transplant.

There are absolute and relative contraindications for lung transplantation. These include:

• Recent history of cancer (at least 5 years of disease-free period required).
• Untreatable disease or dysfunction of major organ systems (combined organ transplants may be necessary).
• Untreated cardiovascular disease.
• Acute medical conditions (sepsis, heart attack, liver failure).
• Uncorrectable bleeding tendency.
• Chronic infections with resistant pathogens that cannot be effectively controlled before the transplant.
• Active tuberculosis.
• Serious chest wall or spinal abnormalities that may cause problems post-transplant.
• Severe obesity (BMI >35).
• Non-compliance with treatment that suggests future non-compliance post-transplant.
• Psychiatric or psychological issues that may interfere with complex treatments and cooperation with the transplant team.
• Lack of or insufficient social support.
• Severe functional limitations that reduce the potential for adequate rehabilitation.
• Substance abuse or misuse (alcohol, tobacco, marijuana, etc.).

How is a Lung Transplant Performed?

Patients deemed suitable for a lung transplant are first placed on a waiting list. The waiting period continues until a matching donor is found. During this time, the patient's lung-related problems are managed with medication and oxygen therapy. The patient’s participation in rehabilitation programs to learn effective breathing techniques also speeds up recovery after the transplant.

Finding a matching donor for a lung transplant can take a long time. Unfortunately, some patients may die during the waiting period. Increasing public awareness of organ donation can provide more hope for patients and their families awaiting a transplant.

Patients on the waiting list must remain alert. As soon as a suitable lung is found, the transplant procedures must begin as quickly as possible. Therefore, the patient should always be reachable and be able to get to the hospital where the transplant will take place on short notice.

Lung transplant surgery is performed under general anesthesia, meaning the patient is unconscious during the operation and does not feel any pain. During surgery, the patient’s breathing is maintained through a tube connected to a machine that delivers air to the lungs. The surgeon makes an incision in the chest wall.

If a single lung transplant is performed, a lateral incision is made; if a double lung transplant is performed, a midline incision is made under the breasts. The damaged lung is then removed through this incision.

The bronchi and blood vessels connected to the removed lung are then connected to the donor lung. This way, the transplanted lung replaces the removed lung. In some lung transplant surgeries, the patient may be connected to a heart-lung bypass machine, which maintains blood circulation throughout the body during the procedure.

How Long Does a Lung Transplant Take?

A single lung transplant surgery can take 4-8 hours, while a double lung transplant can take 6-12 hours.

Are Both Lungs Replaced in a Lung Transplant?

Whether both lungs are replaced depends on technical factors and the patient's condition, as well as the decision of the transplant council. Sometimes a single lung transplant is sufficient for the recipient, while other times a double lung transplant is necessary.

For example, in infectious diseases like bronchiectasis, a double lung transplant is required. In idiopathic pulmonary fibrosis (IPF),a single lung transplant may be performed. Patients who have previously had one lung removed may undergo a single lung transplant. Similarly, single lung transplants may be preferred in elderly patients with COPD.

How Long After a Lung Transplant Can a Patient Be Discharged?

The time it takes for a patient to be discharged after a lung transplant varies depending on any complications that develop after the surgery. Patients without complications can usually be discharged within 4-6 weeks.

How Often Are Follow-up Appointments After a Lung Transplant?

If a lung transplant is successful and no complications develop, the patient is called for follow-up visits two weeks after discharge, then at one month, three months, six months, and annually thereafter. The Lung Transplant Council may adjust the follow-up interval based on the patient’s condition during this process.

Risks of Lung Transplantation

Lung transplants carry risks such as bleeding, blood clotting, infection, and airway closure, which are common risks associated with surgeries performed under anesthesia.

The most significant risk in lung transplantation is organ rejection. Organ rejection can occur immediately after the lung is transplanted or may develop later. Symptoms of organ rejection include shortness of breath, dry cough, rash, and extreme fatigue.

Immunosuppressive drugs used to prevent organ rejection have many side effects, including weight gain, increased facial hair growth, and stomach problems.

Long-term use of immunosuppressive drugs can lead to the development of diabetes, kidney damage, osteoporosis, cancer, and high blood pressure in patients.

While immunosuppressive drugs prevent organ rejection, they weaken the immune system, making the patient more susceptible to infections. Therefore, it is beneficial for transplant patients to pay attention to hygiene rules and avoid infections as much as possible.

Other risks include abdominal pain, nausea, diarrhea, low blood counts, wound separation or narrowing at the surgical site, osteoporosis, high blood sugar, and high blood pressure.

What Happens After a Lung Transplant?

After a lung transplant, the patient must first change their lifestyle and pay close attention to preventive measures, especially those that protect against infections.

In the first six weeks, patients should avoid driving, lifting objects heavier than 2 kilograms, and engaging in strenuous house/garden/repair work. They should try to walk at a comfortable pace and climb stairs.

General Precautions After a Transplant

♦ Because you are taking immunosuppressive drugs, it is recommended to avoid crowded places (cinemas, theaters, concerts, shopping malls, etc.) for three months.

♦ Avoid contact with people who have contagious diseases such as colds, flu, runny nose, or chickenpox.

♦ It is not advisable for transplant patients or their family members to receive live virus vaccines.

♦ You can use the same kitchen utensils and eat at the same table with close family members, and use shared bathrooms.

♦ Dirty kitchen utensils should be washed on the hottest setting of the dishwasher.

♦ Vegetables and fruits should be thoroughly washed with warm water before eating.

♦ Avoid construction sites, demolished roads, and other dusty areas as much as possible. These areas can be sources of infection for you. Wearing a mask in these areas is mandatory.

♦ If you have a bandage on your surgical site, it should always be kept dry and clean. If you notice signs of infection such as redness, fever, pain, or swelling at the surgical site, contact your doctor immediately.

♦ On sunny days, protect yourself from the harmful effects of the sun by wearing a hat, sunglasses, and sunscreen. The medications you take can make your skin more sensitive, increasing the risk of skin cancer. Therefore, sunscreens with a UV protection factor of 45-60 are recommended.

♦ Never sunbathe to tan or use a tanning bed.

♦ Avoid very hot and steamy places such as saunas or Turkish baths.

♦ You can use nail polish. However, avoid manicures, pedicures, or artificial nail applications as they can lead to fungal infections on the hands and feet.

♦ Inform your transplant doctor before undergoing any surgical or dental procedures (fillings, tooth extractions, prosthetics, etc.). Also, inform any doctor you see outside of your regular healthcare provider that you have had a lung transplant.

♦ Your pets at home must be under veterinary control and fully vaccinated. Avoid eating raw seafood.

♦ Avoid eating fresh salads and fruits outside your home if you are not sure they have been thoroughly washed.

♦ Sexual life is not affected by a lung transplant. Although some of the medications used after the transplant may have adverse effects, they generally do not have a negative impact on a person’s sexual life.

Infection Prevention After a Transplant

♦ Take your medications regularly as prescribed by your doctor.

♦ Remember that frequent hand washing is the most effective way to prevent infection.

♦ Do not drink well water or tap water. Instead, use bottled water.

♦ Do not keep live flowers in your home.

♦ Do not share personal items (glasses, eating utensils, toothbrushes, towels, etc.) with others.

♦ It is risky for you if children living with you receive the oral polio vaccine.

♦ Avoid contact with children who have received the oral polio vaccine for at least eight weeks.

♦ You and your family members can get the flu vaccine every fall. However, do not get the inhaled form of the flu vaccine.

Consult your doctor before getting any vaccine made from a live organism. These vaccines include:

• MMR (Measles, Mumps, Rubella)
• Oral Polio (Polio vaccine)
• Chickenpox vaccine
• Typhoid vaccine
• Inhaled flu vaccine

♦ Avoid contact with the body fluids of people who have received a live virus vaccine within the last 90 days.

♦ Do not get any vaccine made from a live organism, as these organisms can cause disease in you.

♦ If you come into contact with someone who has chickenpox, inform your transplant team immediately.

♦ Inform your transplant team when you need to be vaccinated.

♦ Avoid large crowds for six weeks after the transplant.

♦ Children and sometimes adults may develop childhood infections such as chickenpox or mumps. Avoid contact with these individuals in such cases.

♦ If you have a young child at home, always ensure that diapers are changed in a designated area.

♦ Avoid gardening for six months after the transplant. After this period, always use a mask and gloves.

♦ Reptiles (lizards, turtles, snakes, etc.) carry Salmonella bacteria. Do not touch these animals.

♦ Do not forget to wash your hands after touching animals.

♦ Consult your transplant team before acquiring a new pet.

Rejection (Organ Rejection)

Your body may recognize the newly transplanted lung as foreign tissue and try to destroy it. Immunosuppressive drugs are used to prevent this process. Organ rejection may occur in almost everyone within the first one to two months after the transplant. The most important factor in successful treatment is starting organ rejection treatment as early as possible.

If you experience symptoms such as fever, shortness of breath, coughing, or increased phlegm, inform your transplant doctor immediately.

Donors for Lung Transplantation

Lung transplants can use organs from deceased or living donors. In countries like Japan, where organ donation from deceased individuals is less common due to cultural and religious reasons, living donor transplants are more frequently performed.

Is Blood Type Compatibility Necessary for Lung Transplants?

Yes, blood type compatibility is required between the patient and the donor for a lung transplant. Rh factor compatibility is not necessary.

At What Age is a Lung Transplant Performed?

Lung transplants are mostly performed on patients under the age of 65. In some special cases, this limit can be extended to 75 years.

Lung Transplant Cost

In Turkey, lung transplants are free of charge. The costs are covered by the Social Security Institution.

How Long Can a Patient Live After a Lung Transplant?

The average 5-year survival rate after a lung transplant varies between 50-70% depending on the disease.

Can You Live with One Lung?

Yes, it is possible to live a long and quality life with just one lung.

Hospitals Performing Lung Transplants in Turkey

Hospitals in Turkey that perform lung transplants include Ankara City Hospital, Kartal Koşuyolu High Specialization Training and Research Hospital, and Ege University Medical Faculty.