Lung Transplantation -- What- Who- When

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					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

Topics for Discussion
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Organ transplantation in the US Overview of lung transplantation Inadequate supply of lungs for transplantation

University of Minnesota

Major Biomedical Advances 1954-2004
    
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Vaccines Antibiotics Life support technologies Open heart surgery Molecular genetics Organ transplantation

University of Minnesota

Organ Transplantation in the United States
1 Jan 1988 – 31 Jan 2005
Number Organ

Kidney Liver Pancreas* Intestine Heart Lung* Total

201,846 69,057 16,674 977 36,764 13,322 338,640

University of Minnesota

www.unos.org

U of M Firsts in Transplantation
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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

Organization of Transplant Services in the United States
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Department of Health and Human Services
– United Network for Organ Sharing

– Scientific Registry of Transplant Recipients
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Organ Procurement Organizations (LifeSource) Transplant Centers
– Physicians and surgeons – Nurse coordinators

– Social workers – Administrators, financial representatives

University of Minnesota

Types of Organ Donors
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Non-living
– Brain death – Cardiac death

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Living
– Biologically related – “Emotionally” related – Non-directed (“Good Samaritan”)

University of Minnesota

Living Donor Transplantation U.S. Donors by Organ Type (2004)

10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Kidney Liver Pancreas Intestine Lung Non-living donation Living donation

UNOS

Types of Lung Transplants
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Non-living donor
– Single lung – Bilateral (double) – Heart and lung

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Living donor
– Bilateral (double) lobar

University of Minnesota

NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
1800

Number of Transplants

1600 1400 1200 1000 800 600 400 200 0
13 15 46

Bilateral/Double Lung Single Lung
1089

1602 1767 1703 1564 1464 1477 1377 1457 1368

1229 922
708 418 189

83

19 85 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03

ISHLT

2005

Types of Lung Recipients
Pulmonary fibrosis  Emphysema/Alpha-1 antitrypsin deficiency  Pulmonary hypertension
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– Primary – Congenital heart disease
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Cystic fibrosis

University of Minnesota

ADULT LUNG TRANSPLANTATION Indications By Year (Number)
1250
Cystic Fibrosis IPF Emphysema A1A PPH

Number of Transplants

1000

750

500

250

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Transplant Year

ISHLT

2005

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

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Immune system reacts against transplanted organ (rejection)
– Acute – Chronic

Problems after Organ Transplantation

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Medication side effects

University of Minnesota

Outcomes after Lung Transplantation Function  Quality of life  Survival


University of Minnesota

Organ Donors vs. Wait Listed Patients
90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0

“The Growing Need”

1995 1996 1997 1998 1999 2000 2001 2002 2003

Donors

Transplants

Wait List
www.life-source.org

Based on OPTN data as of January 26, 2004.

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

Current Lung Allocation System (1990)
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Who?
– Based on active waiting time only – 90 days of “extra” waiting time assigned to idiopathic pulmonary fibrosis patients (1995)

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Where?
– Lungs offered first to recipients within the donor OPO – Then to recipients within concentric 500 mile circles

University of Minnesota

Goals of the new lung allocation plan
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Reduce waiting list deaths Improve overall survival

University of Minnesota

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

Questions, answers?


				
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