Tuesday, October 4, 2016

Potential Medical Complications of Lung Transplantation - Part 1

While bouncing around the ol' internet looking for information relating to some of my past lab results, I stumbled upon this interesting paper: Medical Complications of Lung Transplantation. I've read quite a few reports about the potential issues that I may see as a direct result of my transplant, or the immunosuppressant medications that I take, I've written about what I do to help prevent skin cancer, avoid infection and counteract the side effects of my meds. This report covers many of the issues all in one place. I learned a couple interesting new tidbits that I thought I'd share.

From the abstract:
As short- and long-term survival rates for lung transplantation continue to improve, and as more lung transplantations are occurring with each year, a multitude of medical complications are encountered by the clinician. This article reviews the long-term non-pulmonary noninfectious medical complications that arise beyond the postoperative period in patients who have undergone lung transplantation.
Now I have to be honest here, this could be one scary paper to read if you or a loved one are considering a lung transplant, or are already waiting on "The List". All I have to say is that an educated patient is an empowered patient, and this ePatient is very happy to have undergone the procedure. The potential of one of these issues popping up can not take away from the 22 months of making new memories with our grandchildren. If one the the issues we are going to talk about reared its ugly head tomorrow, the extended life I've enjoyed so far will be worth it.

Now to the meat of the matter.  The abstract continues:
This article reviews the development of renal failure, diabetes, cardiovascular complications of hypertension and atherosclerosis, osteoporosis and avascular necrosis, hematologic complications, thromboembolic disease, gastrointestinial complications, neurologic complications, and malignancy, including post-transplant lymphoproliferative disorder.
See, I told you it was scary.  Let's talk about these one at a time.

Renal Failure:

This is something that I'm sure everyone who is on '.The List', or has received a transplant, understands.  The medications that keep us from rejecting our lungs are very hard on our renal system. Our teams monitor renal system function very closely at all of our checkups, and a good part of our annual visit is focused on our kidney function.  This is why -
"Renal dysfunction is one of the most common long-term complications of lung transplant, with an incidence of 25.5% at 1 year after transplant and 37.8 at 5 years after transplant. By 6 months after transplant, 91% of lung transplant recipients undergo some degree of renal decline from their baseline pre-transplant level. Chronic renal failure with a creatinine greater than 2.5 mg/dl occurs at an incidence of 6.8% at 1 year after transplant and 11.0% at 5 years after transplant..."
One thing I do to help protect my kidneys is abstain from drinking any kind of alcohol. Alcohol is hard on the kidneys. The team did a great job of explaining this, and how our livers like to metabolize alcohol better than the meds so drinking alcohol will have an effect on the effectiveness of our medications.  I decided that if transplanted, then no more alcohol.  I also drink plenty of water. Early on my labs were off kilter and that was due to my not drinking enough water.

I also eat a very clean diet.  I figure the less crud my kidneys have to filter, the better off they will be.

These are  my Creatinine lab results from over the last year and a half or so.

Diabetes is another potential result of taking anti rejection medications that was well covered by the team prior to receiving my transplant, and is something that they monitor for at every visit.  
"The development of diabetes is a relatively common complication in patients who have undergone lung transplant, with a reported incidence of 24.3% at 1 year after transplant and 33.5% at 5 years after transplant...
...Guidelines for treatment of diabetes for solid organ transplants recommend intervention when patients have fasting glucose levels greater 126 mg/dl and hemoglobin A1C levels greater than 6.5%"
I use the same tools to reduce the risk of diabetes as pretty much anyone else would, diet and exercise. Before my transplant, the team Dietitian really tried to convince me to stop following the Primal Blueprint. It became a point of minor contention prior to the team accepting me as a transplant candidate. She really feels that we should be including whole grains and starchy foods as a major part of our diet. We came to an agreement that I could continue eating as I do so long as they couldn't identify any adverse effects of my diet following my transplant.  Well here we are, 22 months post transplant and I am doing really great.

Here are my A1C lab results -

I was on insulin for the first three months post transplant, but that was procedure and due to the very high level of steroids I was on at the time.

Cardiovascular Complications -

The risk of high blood pressure, high cholesterol, and other cardiovascular issues was also well addressed by my team while I was being evaluated for a transplant.  Monitoring for, and addressing, these issues is an important part of my post transplant care.
"The immunosuppressive medication of lung transplantation results in contributing to the development of cardiovascular comorbidities of hypertension, hyperlipidemia, diabetes, and renal disease. Hypertension is seen in 51.9% of patients who have undergone lung transplant at 1 year and in 85.6% of patients at 5 years. Hyperlipidemia is seen in 20.5% of patients who have undergone lung transplant at 1 year and in 52.2% of such patients at 5 years..."
My team addresses the high blood pressure issue by prescribing the Beta Blocker Metoprolol. I address it via diet and exercise.  Both my resting heart rate, and blood pressure, have significantly decreased over the past year, and the amount of Metroprolol I take has been reduced by a third. My average evening pulse - blood pressure for this week last year was 84 BPM - 117/78. My averages for this past week are 79 BPM - 100/61,  My heart rate is still a bit higher than I would like, but much better than the 100+ BPM it was pre-tx.

My team and I have gone round and round about the necessity of taking a statin drug to control cholesterol.  My team, of course, has won. I learned something from this study, that if my team had mentioned, would have convinced me of the importance of taking a statin.
The use of HMG Co-A reductase inhibitor medications (statins) has been shown to effectively lower cholesterol levels while demonstrating decreased acute rejection episodes and prevention of bronchiolitis obliterans syndrome when the statins were started in the within the first year of transplant. Patients on statin medication had better spirometry readings and improved mortality.
That right there is a good enough reason to take statins if you have had a lung transplant.

My cholesterol labs -
Osteoporosis -

I've talked a lot about post-transplant bone density, and minimizing this risk is a major focus of my little N-1 experiment on post-tx general health. Here's what the report states the issue:
"Osteoporosis is a complication of lung transplantation that can cause significant negative impact on quality of life and on morbidity due to related fractures. Solid organ transplantation has long been established to be associated with a high incidence of osteopenia and osteoporosis. The use of corticosteroids and other immunosuppressive medications are believed to have the largest impact of causing osteoporosis, although other factors are implicated as well..."
 If you are interested in a more in depth explanation of  what I'm doing for my bones, you can click the link above.  Basically it involved diet, exercise and supplements.

There is more on this list of potential complications of lung transplant.  This is just Part 1 of a two part series.  If you have read this far, you can see that there are actions that we as empowered and educated patients can take to help ourselves to "Live Long and Prosper".  I don't know where that come from, but what the heck.

Please remember that I am an educated patient, not a medical authority. If my thoughts give you any ideas about things you can do with your own diet or exercise program, please talk about it with your own team before making any changes.  Each situation is different and we all have our own unique to us medicine cocktail that our teams have dialed in for us.

If you have received a lung transplant, what do you do to help minimize the risk of these complications?

Medical Complications of Lung Transplantation - Part 2


  1. Good job John. With the exception of the statistics and the additional reason for the statins, these were very well covered by my respirologist before referring me 3 years ago and were reviewed again during the education session this summer. I'm sure the surgeon next month will also be reviewing them. As you say informed is ePowered. Doesn't mean these will happen to me. Heck some not even on the list could happen. But life is a risk no matter what. Thank you.

    1. Thanks Barbara, Part 2 has a couple of things that I didn't know about (remember?). It is issues like these that make a meta data study on tx recipients so important. I'm trying to generate interest in a data study that includes everything. Diet, exercise, how many times we fly on an airplane, sun exposure, play, sex, general attitude, everything. The answer to all cause mortality is not just to be found in clinical data.