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Lung Transplantation: What? Who? When?

Lung Transplantation: What? Who? When?. Marshall I. Hertz, MD University of Minnesota Medical School and Fairview-University Medical Center Medical Director, Lung Transplantation Director, Center for Advanced Lung Disease. Organ transplantation in the US Overview of lung transplantation

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Lung Transplantation: What? Who? When?

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  1. Lung Transplantation:What? Who? When? Marshall I. Hertz, MD University of Minnesota Medical School and Fairview-University Medical Center Medical Director, Lung Transplantation Director, Center for Advanced Lung Disease

  2. Organ transplantation in the US Overview of lung transplantation Inadequate supply of lungs for transplantation Topics for Discussion University of Minnesota

  3. Major Biomedical Advances 1954-2004 • Vaccines • Antibiotics • Life support technologies • Open heart surgery • Molecular genetics • Organ transplantation University of Minnesota

  4. Organ Transplantation in the United States1 Jan 1988 – 31 Jan 2005 www.unos.org University of Minnesota

  5. U of M Firsts in Transplantation • 1963: First kidney transplant in Minnesota • 1966: First pancreas transplant in the world • 1966: First intestinal transplant in the world • 1968: First successful human bone marrow transplant • 1978: First heart transplant in Minnesota • 1978: First living-donor pancreas transplant in the world • 1981: First pediatric heart transplant in Minnesota • 1986: First heart-lung transplant in Minnesota • 1988: First lung transplant in Minnesota • 1991: First living-related lung transplant in Minnesota • 1996: First living donor liver transplant in Minnesota

  6. Organization of Transplant Services in the United States • Department of Health and Human Services • United Network for Organ Sharing • Scientific Registry of Transplant Recipients • Organ Procurement Organizations (LifeSource) • Transplant Centers • Physicians and surgeons • Nurse coordinators • Social workers • Administrators, financial representatives University of Minnesota

  7. Types of Organ Donors • Non-living • Brain death • Cardiac death • Living • Biologically related • “Emotionally” related • Non-directed (“Good Samaritan”) University of Minnesota

  8. Living Donor TransplantationU.S. Donors by Organ Type (2004) UNOS

  9. Types of Lung Transplants • Non-living donor • Single lung • Bilateral (double) • Heart and lung • Living donor • Bilateral (double) lobar University of Minnesota

  10. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE 1602 1767 1703 1564 1464 1477 1377 1457 1368 1229 1089 922 708 418 189 83 15 46 13 ISHLT 2005

  11. Types of Lung Recipients • Pulmonary fibrosis • Emphysema/Alpha-1 antitrypsin deficiency • Pulmonary hypertension • Primary • Congenital heart disease • Cystic fibrosis University of Minnesota

  12. ADULT LUNG TRANSPLANTATIONIndications By Year (Number) ISHLT 2005

  13. Characteristics of Lung Transplant Recipients with Pulmonary Fibrosis • Severe disease • Breathing tests (PFT) • Exercise limitation (6-min. walk) • Pulmonary hypertension (Echo) • Age <65 years (55 for bilateral, 45 for heart-lung) • Capable of following complicated medication schedule • No severe disease in other organs (kidney, heart) • Non-smoking, non-drinking University of Minnesota

  14. Problems after Organ Transplantation • Immune system reacts against transplanted organ (rejection) • Acute • Chronic • Medication side effects University of Minnesota

  15. Outcomes after Lung Transplantation • Function • Quality of life • Survival University of Minnesota

  16. “The Growing Need”Organ Donors vs. Wait Listed Patients Based on OPTN data as of January 26, 2004. www.life-source.org

  17. The Donor Shortage:Possible Approaches • Use more non-living donors • Increased public awareness • Presumed consent laws • “Breakthrough collaborative” • Use more living donors • Xenotransplants, bioartificial lungs, stem cells • Make better use of existing non-living donors University of Minnesota

  18. Current Lung Allocation System (1990) • Who? • Based on active waiting time only • 90 days of “extra” waiting time assigned to idiopathic pulmonary fibrosis patients (1995) • Where? • Lungs offered first to recipients within the donor OPO • Then to recipients within concentric 500 mile circles University of Minnesota

  19. Goals of the new lung allocation plan • Reduce waiting list deaths • Improve overall survival University of Minnesota

  20. New lung allocation plan(May 4, 2005) • Based on disease type, disease severity, and expected survival after transplant • Scores range from 1 to 100 • Patient information has to be updated every 6 months • Blood group, size, and geography still matter • Time on wait list does not count University of Minnesota

  21. Questions, answers?

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