Optimizing Your Health for Transplantation

There are a variety of things that a patient should do before and after a transplant to improve their chances of having a successful surgery and to maintain the health of their new lung(s). This includes making sure that all required immunizations have been received before surgery, participating in a pulmonary rehabilitation program, and eating properly before and after the transplant.

Immunizations

We require all patients to have an annual flu shot, a pneumonia vaccine (pneumovax), up-to-date tetanus shots (within the last ten years), and Haemophilus influenzae type B (Hib) vaccine.

Pre-Transplantation Pulmonary Rehabilitation

As a result of your lung condition, you may have developed several associated problems that need to be addressed. These include:

  • Shortness of breath and increased oxygen need
  • Decreased activity level
  • Deterioration of your muscle groups, including respiratory muscles, postural or trunk muscles, and your arm and leg muscles
  • Cardiovascular deconditioning
  • Fear or anxiety due to breathlessness

Evaluation in a pulmonary rehabilitation program is essential in order to be considered for transplantation. It is important that you be in the best physical shape possible at the time of your surgery. Failure to reliably participate in a pulmonary rehabilitation program prior to lung transplantation will result in being removed from the waiting list. Our Pulmonary Rehabilitation Program is offered at Brigham and Women’s Faulkner Hospital (in Jamaica Plain).

Lung transplantation will improve your shortness of breath and oxygen need. A comprehensive rehabilitation program will improve the other problems. Therefore, you will be introduced to the importance of exercise and activity before your transplant.

Before your surgery, you will take part in an outpatient pulmonary rehabilitation program. Following an evaluation, we will work with you to develop an exercise program. This will include training for your respiratory muscles, as well as a biking or walking program for your general conditioning. Continuing to exercise after your transplant is also very important.

Nutrition

Proper nutrition plays a key role in preparing for lung transplantation. Therefore, you will meet with the lung transplant dietitian during your evaluation. During this initial interview, you will discuss your weight and weight history, the foods you typically eat, and your appetite. At this time, you also will receive information about the amount of calories, protein, vitamins, and minerals you will need to maintain your current nutritional status, as well as any required weight gain or weight loss. Making sure that you are within your ideal body weight range for your height helps assure that you will be in good physical condition for your pre-transplant pulmonary rehabilitation, as well as for the transplant itself. Certain patients with advanced pulmonary disease are unable to eat enough to maintain ideal body weight because of increased metabolic demands and breathlessness with eating. In such situations, it may be recommended that a feeding tube be placed in the gastrointestinal tract through the abdominal wall. This requires a small surgical procedure and allows patients to receive nutrition at night and improves nutritional status both before and after the transplant.

Proper nutrition is critical to maximizing the chances of a successful transplant and also can impact the timing of a transplant. After a patient is approved for a transplant, that patient is added to a list with other people who are waiting for a donor lung. Occasionally, listing for transplant will be delayed until the patient's nutritional status improves. If a patient experiences deterioration in their nutritional status after being listed with The New England Organ Bank, that patient will be temporarily ineligible for a transplant until their nutritional health improves.

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