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What Is Lung Transplantation?

Lung transplantation is major thoracic surgery that replaces one or both severely diseased lungs with healthy donor lungs, usually from a deceased donor. A single-lung transplant replaces one lung, while a bilateral sequential transplant replaces both lungs one at a time. The donor bronchus, pulmonary artery, and pulmonary veins are surgically connected to the recipient's airway and circulation. Transplantation can improve survival and quality of life for selected patients with end-stage lung disease but requires lifelong immunosuppression and transplant follow-up.

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What Is Lung Transplantation?

Lung transplantation is major thoracic surgery that replaces one or both severely diseased lungs with healthy donor lungs, usually from a deceased donor. A single-lung transplant replaces one lung, while a bilateral sequential transplant replaces both lungs one at a time. The donor bronchus, pulmonary artery, and pulmonary veins are surgically connected to the recipient's airway and circulation. Transplantation can improve survival and quality of life for selected patients with end-stage lung disease but requires lifelong immunosuppression and transplant follow-up.

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Why Is Lung Transplantation Performed?

The procedure is considered for advanced lung disease that severely limits survival or daily function despite optimal medical, surgical, and rehabilitative treatment. Common indications include pulmonary fibrosis, chronic obstructive pulmonary disease, cystic fibrosis or severe bronchiectasis, pulmonary hypertension, and selected other irreversible lung disorders. Transplant evaluation examines lung function, heart and kidney health, infections, cancer risk, nutrition, physical conditioning, adherence, psychosocial support, and expected post-transplant benefit. The choice between single and bilateral transplantation depends on the underlying disease, donor availability, anatomy, age, and transplant-center strategy.

How Is Lung Transplantation Performed?

The operation is performed under general anesthesia through a chest incision selected for a single or bilateral transplant. The surgeon removes the diseased lung and connects the donor bronchus, pulmonary artery, and a cuff of donor pulmonary veins to the recipient's airway and left atrium. In a bilateral sequential transplant, the lungs are replaced one after the other during the same operation. Cardiopulmonary bypass or extracorporeal membrane oxygenation can be used when the heart and lungs cannot maintain adequate circulation and oxygenation during implantation.

What Is Recovery Like After Lung Transplantation?

Patients initially recover in an intensive-care unit with mechanical ventilation, chest tubes, pain control, and close monitoring of the donor lungs. Immunosuppressive medicines are started to prevent rejection and must be taken for the life of the transplant. Early rehabilitation focuses on breathing, walking, strength, nutrition, and gradual return to daily activity, while frequent lung-function testing and bronchoscopy help monitor graft health. Long-term follow-up remains intensive because infection, acute rejection, airway problems, and chronic lung allograft dysfunction can develop even years after surgery.

What Are the Risks and Complications?

Possible early complications include bleeding, infection, blood clots, airway-anastomotic problems, kidney injury, and primary graft dysfunction during the first days after transplantation. Acute cellular or antibody-mediated rejection can damage the transplanted lung despite immunosuppressive treatment. Immunosuppression increases susceptibility to serious infections, kidney dysfunction, metabolic disease, and certain cancers. Chronic lung allograft dysfunction can cause progressive, largely irreversible loss of graft function and remains a major limitation to long-term transplant survival.

Frequently Asked Questions About Lung Transplantation

Can one lung or both lungs be transplanted?

Yes. Some conditions can be treated with a single-lung transplant, while others are better treated with bilateral transplantation depending on the disease and patient factors.

Do lung transplant recipients need lifelong immunosuppression?

Yes. Anti-rejection medicines are required for the life of the transplant because the immune system can attack the donor lung or lungs.

What is primary graft dysfunction after lung transplantation?

Primary graft dysfunction is an acute form of lung injury that develops within the first 72 hours after transplant and can cause severe problems with oxygenation.

What is chronic lung allograft dysfunction?

It is progressive, largely irreversible dysfunction of the transplanted lung and includes major patterns such as bronchiolitis obliterans syndrome and restrictive allograft syndrome.

References

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. PubMed. https://pubmed.ncbi.nlm.nih.gov/34419372/. Date Accessed September 11, 2026.

Graft dysfunction and rejection of lung transplant, a review on diagnosis and management. PubMed. https://pubmed.ncbi.nlm.nih.gov/35080130/. Date Accessed September 11, 2026.

Lung transplant. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/lung-transplant/about/pac-20384754. Date Accessed September 11, 2026.

Lung transplant: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/003010.htm. Date Accessed September 11, 2026.

Primary graft dysfunction after lung transplantation. PubMed. https://pubmed.ncbi.nlm.nih.gov/37053083/. Date Accessed September 11, 2026.