¶ Lung Transplant Overview at UK Health
Another informational resource from UK.
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Featuring conversations with our physicians and other healthcare providers. Here's Miller.
This is UK Healthcast with the University of Kentucky Healthcare. I'm Melanie Cole, and today we're talking about lung transplant at UK Health. Joining me in this panel is doctor Sravanthi Nandavaram, she's a transplant pulmonologist, and doctor Maher Baz, he's the medical director of lung transplant, and they're both at UK Health. Dr. Boz, I'd like to start with you. Tell us a little bit about how common lung transplant is, and give us a little history at UK Health with lung transplants.
So lung transplant is a Treatment modality we apply for patients with advanced lung diseases My definition of advanced lung disease is when all medical and surgical options have been exhausted and a patient is on oxygen. That early stage when they're on oxygen. across all lung problems. Uh across the spectrum from coal workers' lung to smoker's lung. And uh those patients, the majority were able to give him extended life
uh if we transplant'em. Um in emphysema patients we aim for improved quality of life. UK specifically has been doing lung transplants since nineteen ninety one and we have recently been doing twenty five to thirty the last uh two or three years, which is a little bit of increase in the number, with one year outcome above the national average uh in the low nineties.
And that is because of the multidisciplinary team approach that includes our thoracic surgeons, our transplant pulmonologists, our nurse coordinators, our physical therapists, uh, our uh social workers.
¶ Innovations and Referral Indications
doctor Baz stickin' with you for just a second. What's exciting in the field that's changed that you feel that other providers really want to know about? What what are some of the very exciting technologies, changes, medications, things going on in your field that you want other providers to know about?
So I've been in this field close to Twenty seven, twenty eight years. So the few things that have changed recently is now we're able to place patients on mechanical ventilation or ECMO if they're on the waiting list, good transplant candidates. uh and we can't find them lungs we can keep them alive with modalities such as ventilator or eCmo. ECMO is a
is a machine that can support the patient's breathing until we can find them lungs. This is relatively new the last few years. The other relatively new thing that we're doing at UK is we're part of multi center research efforts in addressing chronic lung rejection, which is a complication that happens in many patients several years after transplant. being inhaled cyclosporine and photophoresis. Uh we are part of multi center.
trials to try to study the lung function, to try to uh control the chronic lung rejection, which is new and unique uh the last uh year or two we've been part of. And the third thing is uh with repetition, you know, the team gets better at at handling complications, recognizing them early and uh uh preventing, you know, hospitalizations and bad outcomes. And I think we have all three here at the University of Kentucky.
Doctor Nanda Varum, for providers that are looking for referral. Tell us a little bit about patient selection criteria and some general indications for transplantation for patients that they may have that have been dealing with lung issues for a while.
Lung transplant is a treatment option for anyone with advanced lung disease. So I usually say anyone who's requiring oxygen needs to be referred to a transplant pulmonologist. if the lung disease is irreversible. And the reason I say that is lung transplant is a complex procedure which needs a multidisciplinary and a multi organ assessment which is not gonna happen overnight and we need some time to evaluate the patient and S's if the patient is a good candidate for surgery or not.
So again I would say that anyone who is requiring oxygen should be referred to a transplant pulmonologist if the primary physician thinks that the disease is irreversible. And some of the indications for lung transplant include C O P D or emphysema, pulmonary fibrosis, any kind of interstitial lung disease, bronchiactasis.
Cystic fibrosis, pulmonary hypertension, occupational lung disease like cold workers, pneumocnosis or silicosis, or other rare pulmonary diseases like lamb or lymphangiole myidosis. or any other vasculitis disorders, these are all indications for lung transplant. And we usually urge the tertiary physicians or the community physicians to refer the patients to us as soon as possible so that we have enough time to evaluate these patients and put them on the list.
It's not just the evaluation and listing the patients. Once the patients are on the list, we need to wait for the lung. So we do need enough time.
¶ Navigating the Lung Transplant Waitlist
What's involved in that wait time? How's it calculated? What's involved in the management of patients on the wait list, Dr. Nandavaro?
So once the patients are evaluated by our multidisciplinary team and once they undergo all the testing Based on um some of those test results, we calculate a score called lung allocation score, which is a universal score wherein it tells us how sick the patient is. Certain variables that are used to calculate the score include like the type of lung disease, how much oxygen they are on, what are their uh pulmonary, artery, systolic pressures, how are their lung volumes.
So this calculator basically calculates a score based on certain variables, and that score tells us how sick the patient is. Higher the score, sicker the patient, lower the score, less sick. So usually patients with higher score their wait time is less. And the patients with lower score, their wait time is low. And once we put these patients on the wait list we start looking for lungs and we do have uh donor coordinators who
job is just to find donors for the patients who are on the waiting list. And while the patients are on the waiting list, our job is to make sure they are doing well in terms of their general uh health status. making sure they're strong enough so that we make sure patients are attending pulmonary rehab even before the transplant.
so that their muzzle strength is good enough and they are in a better shape to go for the surgery. And while the patients are on the wait list, we bring them to the clinic every couple of months to make sure they're doing well. We keep an eye on their pulmonary function tests, we do uh blood work like blood gases, we do echocardiograms to monitor the progression of disease.
and we update the score because while they are waiting on the list we need to make sure they're not getting sicker and we keep updating the score and if they are getting sicker they'll get the lung sooner.
¶ Future of Lung Transplant and UK's Strengths
Doctor Baas and thank you Doctor Nandavaram for that very comprehensive answer. Doctor Baes Tell us a little bit about the future of lung transplantation and the several issues such as ongoing shortage of donor organs that's fueled the search for alternative therapies for failing lungs, challenges. and organ shortage, chronic rejection, some of the things that we've mentioned in this podcast.
Speak about what you see happening in the future and what you hope will happen. You've been in this business a very long time. What do you hope to see happen in the future?
So what I would hope is it's a two sided equation. One is, you know, get more patients transplanted. uh the corolla that is is decrease the deaths on the waiting list. In the nineties and early part of the century it used to be first come, first serve. So the waiting t list was by waiting time. It didn't matter how thick you were.
And uh we realized that, you know, we were losing patients. So in two thousand and five this new lung allocation score that Dr. Nandavarum uh talked about came into being in May of two thousand and five and it
It prioritizes the sicker patients. So if you are sicker you could score higher, you could be on the top of the list from day one rather than waiting time. But we still lose patients. I think the way around it is to keep advertising, word of mouth, uh in in in any way we can about we need more organ donors, more organ donors, more organ donors.
Only about twenty percent of organ donors can donate lungs compared to about seventy, eighty percent kidneys. The other thing I see that's exciting in the organ donation is we're learning more and more about how to better preserve the lungs So so the travel time could potentially be longer. meaning, you know, a center could maybe five or ten years from now when we perfect the uh
technology uh could fly three four hours, get along and come back. Uh now we'd like to fly no more than two hours if we can help it. There is uh also what we call uh perfusion runs. Um if a lung we're not sure, you know, we can use it or not, we can put it on a uh lung perfusion machine and monitor the function of the lung.
the next four or six hours before we decide, you know, we can use it. Those are all technologies I think in five to ten years we will know if they will bear fruit. Uh we're hoping they will, but in five or ten years we'll know better. That's on the front end. On the back end after transplant, so we want to transplant more. Healthier, successful transplant. Once we do transplant, we're hoping with the research we're doing, whether it is photophoresis, whether it is inhaled cyclosporine,
or any other, you know, study that could be coming uh down the pike uh that will decrease chronic lung rejection. But we're really hopeful that between photophoresis or inhaled cyclosporum we'll be able to make a dent in the in the in the outcomes of chronic lung rejection if chronic lung rejection happens a few years later and prolonged survival further than the average of five or six years that we have right now.
While you're summarizing, doctor Bos, what makes the transplantation program at UK stand apart from others in the state?
I think access. I mean we have clinics every day. We can see patients on a few days notice. When we send uh letters out to referring physicians we always include our cell numbers. We always try to call patients. So we try to give out our cell number to physicians. So I think access is important for patients and for physicians. Physicians to find us quickly and patients to get in uh the clinic quickly.
I think uh repetition, uh, like I mentioned between the surgeon, myself and my partner, Doctor Nandavarum, we probably have fifty years of experience between uh between us. So when you have repetition, you're more likely to recognize things quicker, uh minimize complications, minimize poor outcomes. Uh our one year survival is higher than the national average. And the last thing is, you know, we have the two research
projects that I've talked about, multi center, one is sponsored by CMS and another one is sponsored by pharmaceutical. The photophoresis uh Medicare sponsored study and the inhale cyclosporin by pharmaceutical. Each about fifteen centers uh in each study. So I think access, I think uh experience, excellent money or survival and and research into the complicated
¶ Importance of Early Patient Referral
Doctor Nandavaram, last word to you. What would you like other providers to know about the importance of early referral? and your team at the University of Kentucky Healthcare.
I would like them to know that we are easily accessible. They can call us anytime. They can send the patients anytime. And even if it's a question whether to send a patient to us or not, they can send us. And if the patient doesn't need lung transplant, that's all right, we will tell them. But I urge everyone, each and every physician not to delay the referral for lung transplant. That's where we lose the patient.
And early referral is the key. And referral doesn't mean that the patient is gonna go on the list. We will do our diligent work up before we put a patient on the list. So again, early referral once a patient is requiring oxygen, once they are deemed to have advanced lung disease or irreversible irreversible lung disease, the patient needs to be referred to a transplant pulmonologist. That would be the one thing, one point that I would tell if regarding the lung transplant referral.
Thank you both so much for joining us today and sharing your expertise and telling us about the transplantation program at the University of Kentucky Healthcare. And that wraps up another episode of UK HealthCat. For more information about the lung transplant programmer to find a UK Healthcare specialist, a community physician can refer a patient to UK healthcare with UKMD.
At one eight hundred eight eight eight five five three three, or you can visit our website at UK Healthcare dot UKY dot EDU. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky healthcare podcasts. I'm Melanie.