To watch a videotaped interview with this patient, visit clevelandclinic.org/transplant. clevelandclinic.org/transplant

Transcription

1 DONNA WILLIAMS DOUBLE LUNG TRANSPL ANT RECIPIENT I feel like I m 16 years old. I can t be still. Donna Williams, 59, Cleveland. Chronic obstructive pulmonary disease left Donna exhausted from even the simplest of daily activities, such as combing her hair, talking and cooking. After undergoing a double-lung transplant, Donna now enjoys roller skating, babysitting her granddaughter, running errands for her neighbor and exercising at the local YMCA. To watch a videotaped interview with this patient, visit.

2 LUNG AND HEART/LUNG TRANSPLANTATION Leadership 2009 Highlights Surgeons at Cleveland Clinic performed 157 lung transplants in 2009, setting an international record for lungs transplanted in a single year. We completed our 840 th transplant since the program s inception in We attribute the high numbers and excellent outcomes to factors including more aggressive donor utilization, teamwork and strong institutional support. The transplant program has established a reputation for accepting challenging, complex cases, which has led to a high referral rate. In 2009, the transplant team evaluated 562 end-stage lung disease patients from across the United States and other countries. The program s average waiting time for a graft remains stable, despite the new lung allocation score (LAS). Almost one-third of patients listed get new lungs within 30 days, and 90 percent get a new organ within a year (compared to only 40 percent nationally). Our hospital and 30-day mortality remain low despite heightened case severity resulting from LAS giving priority to the sickest patients. The lung transplant program has achieved very strong survival rates that are at or above national averages. Median and long-term outcomes continue to improve, with a 1-year survival rate of 85.4 percent, and 2-year survival rate of 77.2 percent. A continued emphasis on quality assurance and quality improvement remains central to the program, reflected by a post-transplant length of stay of a median of 19 days. Marie M. Budev, DO, MPH, FCCP Program and Medical Director, Lung Transplant Kenneth McCurry, MD Program and Surgical Director, Lung and Heart- Lung Transplant (2010) L U N G A N D H E A R T / L U N G T R A N S P L A N T A T I O N In 2009, we welcomed Kenneth McCurry, MD, Program and Surgical Director, Lung and Heart-Lung Transplant, to lead our team. He is a cardiothoracic surgeon specializing in heart failure; and heart, lung and combined heart-lung transplantation in adults and children. Dr. McCurry joined the Cleveland Clinic staff from the University of Pittsburgh where he was head of the Section of Cardiothoracic Transplantation, director of lung and heart-lung transplantation, director of cardiac transplantation, surgical director of clinical heart failure research and surgical director of pediatric lung and heart-lung transplantation. Gösta Pettersson, MD, PhD Program and Surgical Director, Lung and Heart- Lung Transplant (2009) See pages for complete staff listing 56 57

3 Fast facts Set world record for number of lung transplants performed in a single year: 2009 Initiation date: 1990 First Adult Lung Transplant: February 14, 1990 First liver-lung transplant: January 31, 2007 First double lung transplant with bronchial artery revascularization performed December 15, 2007 at Cleveland Clinic. Performed first lungliver transplant in Ohio in UNOS approval: March 3, 1993 Medicare Approval: October 22, 1997 As of December 31, 2009, 840 lung transplants have been performed at Cleveland Clinic. Marie Budev, DO, was designated as the UNOS Primary Physician and Medical Director for the Lung Transplant Program in Dr. McCurry was designated as the UNOS Primary Surgeon and Surgical Director in Research and Innovations The Cleveland Clinic lung transplant team is involved in a series of multicenter trials focusing on primary graft dysfunction and acute rejection therapy, as well as on induction therapy and ex vivo perfusion. Currently, Cleveland Clinic is a leading center for evaluating the safety and efficacy of cyclosporine inhalation in preventing chronic rejection in lung transplant recipients. In 2007, Cleveland Clinic lung transplant surgeons initiated a study offering bronchial artery revascularization (BAR) in an effort to reduce impaired airway healing after lung transplantation. During a lung transplant with BAR, surgery includes an additional connection between a recipient artery and the diminutive donor lung bronchial arteries. Thus, a normal bronchial blood supply is restored. Currently, 16 patients have been transplanted with BAR. All patients are alive, and 15 of 16 had excellent airway healing. In April 2009, these results were presented at the International Society for Heart & Lung Transplantation meeting in Paris. Currently, more than 50 patients are enrolled in the BAR pilot study. Additionally, surgeons look forward to completing even more lung transplants in 2010, as a greater use of donation after cardiac death (DCD) could help increase the number of transplants. While most transplanted organs come from donation after brain death, a Cleveland Clinic study that evaluated all DCD lung transplants performed in the United States from 1987 to 2007 determined that survival after lung transplant using DCD donors was excellent and, in fact, better than survival after brain death donation. Expertise Our highly experienced physicians are frequently sought for their opinions and advice. They have served on the advisory boards of various organizations that have helped advance lung transplantation, including the American Thoracic Society (ATS), International Society for Heart and Lung Transplantation (ISHLT), United Network for Organ Sharing (UNOS), the American College of Chest Physicians (ACCP) and the World Transplant Congress (WTC). As part of a statewide quality assurance program, we continue to actively participate in the State of Ohio Solid Organ Transplantation Consortium, providing educational programs and hosting site visits for other programs in the state.

4 Survival analysis: patient survival for 406 primary lung transplants (includes 9 heart/lung and 4 lung/liver) Phone Number Time Survival % 6 months year years 77.2 Lung transplants 2009 Number Percent Double Single (27 left and 19 right) Total 157* * includes 5 re-transplants Lung transplant mortality 2009 Hospital deaths (within 30 days post-transplant) 8* * includes 1 lung/heart and 1 lung/liver Number of lung transplants Single Double Total L U N G A N D H E A R T / L U N G T R A N S P L A N T A T I O N * ** *** **** 157 Total * (includes 1heart/lung) ** (includes 2 heart/lung) *** (includes 3 heart/lung and 1 lung/liver) **** (includes 3 heart/lung and 3 lung/liver) 58 59

5 Number of transplants Organ Double Single Total Lung Heart/Lung Lung/Liver 4 4 Total Days on waiting list and post-transplant length of stay (LOS) for lung patients transplanted in 2009 Mean Median Number Days waiting Post-transplant LOS * * 6 patients not discharged as of February 4, Primary diagnoses for patients transplanted in 2009 Diagnosis Number Percent Idiopathic pulmonary fibrosis COPD/emphysema Cystic fibrosis Pph (Primary pulmonary HTN) Re-transplant/graft fail Sarcoidosis Alpha-1 antitrypsin deficiency Bronchiectasis Other Total 157

6 Publications Cuellar-Rodriguez J, Avery RK, Lard M, Budev M, Gordon SM, Shrestha NK, van Duin D, Oethinger M, Mawhorter SD. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis Sep 1;49(5): Danziger-Isakov LA, Worley S, Michaels MG, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, Eichler I, Elidemir O, Goldfarb S, Mallory GB, Mogayzel PJ, Parakininkas D, Solomon M, Visner G, Sweet S, Faro A. The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation May 27;87(10): Liu M, Worley S, Mallory GB, Jr, Arrigain S, Robertson J, Schecter MG, Elidemir O, Danziger-Isakov LA. Fungal infections in pediatric lung transplant recipients: colonization and invasive disease. J Heart Lung Transplant Nov;28(11): Liu M, Worley S, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, Eichler I, Elidemir O, Goldfarb S, Mallory GB, Mogayzel PJ, Parakininkas D, Visner G, Sweet S, Faro A, Michaels M, Danziger-Isakov LA. Respiratory viral infections within one year after pediatric lung transplant. Transpl Infect Dis Aug;11(4): Mason DP, Little SG, Nowicki ER, Batizy LH, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Temporal pattern of transfusion and its relation to rejection after lung transplantation. J Heart Lung Transplant Jun;28(6): Mason DP, Batizy LH, Wu J, Nowicki ER, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Matching donor to recipient in lung transplantation: How much does size matter? J Thorac Cardiovasc Surg May;137(5): e1. McCurry KR, Shearon TH, Edwards LB, Chan KM, Sweet SC, Valapour M, Yusen R, Murray S. Lung transplantation in the United States, Am J Transplant Apr;9(4, pt 2): McCurry KR, Shearon TH, Edwards LB, Chan KM, Sweet SC, Valapour M, Yusen R, Murray S. Lung transplantation in the United States, Am J Transplant 2009;9(4, pt 2): L U N G A N D H E A R T / L U N G T R A N S P L A N T A T I O N Shakoor H, Murthy S, Mason D, Johnston D, Shah SS, Carrillo MC, Mehta AC. Lobar torsion after lung transplantation a case report and review of the literature. Artif Organs Jul;33(7): Stephany BR, Boumitri M, Budev M, Alao B, Poggio ED. Absence of proteinuria predicts improvement in renal function after conversion to sirolimus-based immunosuppressive regimens in lung transplant survivors with chronic kidney disease. J Heart Lung Transplant Jun;28(6): Yun JJ, Mason DP. Lung transplantation: past, present, and future. Minerva Chir Feb;64(1):