After Your Lung Transplant

You will have frequent visits with your lung transplant team for the first two or three months after you leave the hospital. At every follow-up visit, you will meet with members of your team and undergo testing to see how well you’re healing, monitor any medication side effects, and look for signs of rejection. Over time, these visits will occur less often, but you will still need to return to Duke for follow-up appointments -- in most cases twice a year. Your transplant coordinator will help you with your appointment schedule. Video visits are offered in many states.

You are required to participate in 23 or more physical therapy sessions (which takes about six weeks) through the Duke Cardiac and Pulmonary Rehabilitation Program. The pulmonary physical therapy staff will work with you to ensure you are exercising effectively and safely. Staying active can prevent some of the side effects of your medications and is one of the best things you can do to live a longer and healthier life. You are expected to exercise regularly for the rest of your life and will receive a detailed activity plan to use when you return home.

Rejection episodes are common for transplant recipients. In most cases, especially if detected early, they can be treated by increasing your dose of anti-rejection medication or with high-dose steroids. Signs of rejection may include fever, shortness of breath, decreased exercise tolerance, or lower pulmonary function. Many times, though, rejection occurs with no symptoms at all.

To check for the presence of rejection, you will have biopsies of your transplanted lungs (bronchoscopies) on a regular basis. During a lung biopsy, a flexible tube with a light and a camera at the end (called a bronchoscope) will be inserted through your nose or mouth and into your lungs. Your doctor will examine your lungs through the bronchoscope and collect samples of lung tissue. This material will be sent to a lab and tested for signs of rejection and infection. Most of the times, bronchoscopies are done at one month, three months, six months, nine months, twelve months, and then once a year unless there is a problem with your lungs. In this case, bronchoscopies may be done more frequently.

In addition to lifelong immunosuppression drugs, you will need to take other types of medications. For instance, you may take steroids, drugs to help you avoid infections, vitamins, or medications to control acid reflux. Your transplant pharmacist, transplant coordinator, and others will help you manage and follow your medication routine.

To help your transplant team track your progress, you will be asked to record your lung function (with a micro spirometer that we will provide), your weight, and other vital signs and bring these records to your follow-up appointments. Changes in blood pressure, heart rate (pulse), temperature, and weight may indicate a need for medical attention.

To increase the chances of a successful lung transplant, you will need to permanently abstain from using tobacco in any form. It is also important to follow the exercise routine recommended by your physical therapist, maintain a well-balanced diet, and take your medications as prescribed.

Your immunosuppression medications help your body accept your new lungs, but they also increase the risk for infections, such as a cold, the flu, or other viral or fungal illnesses. This risk is greatest when you are on high doses of medication -- for instance, when you are being treated for an episode of rejection. You can lower your risk for infection by consistently washing your hands, avoiding crowds and sick people, and getting vaccines as recommend by your doctor.

As a Duke lung transplant recipient, you are our patient for life. We can provide you and your caregivers the resources and support you need -- right after surgery and in the years to come. We know it is not always easy to follow new activity, diet, and medication requirements, but our transplant coordinators are always available to answer your questions and address your concerns. They can also connect you with other lung transplant recipients at Duke.