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Promising Technology and Research in Lung Transplantation
Northwestern Medicine has one of the premier organ transplantation programs in the country including a renowned lung transplantation program. Rade Tomic, MD, is a pulmonologist and the medical director of the Lung Transplant Program at Northwestern, joins us today to share more about the program and highlight some of the latest advances in the field.
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Learn more aabout Rade Tomic, MD
Rade Tomic, MD
Rade Tomic, MD, Medical Director of Lung Transplant Program at Northwestern Medicine and Associate Professor of Medicine in the Division of Pulmonary and Critical Care.Learn more aabout Rade Tomic, MD
Transcription:
Promising Technology and Research in Lung Transplantation
Melanie Cole, MS (Host): Northwestern Medicine has one of the premier organ transplantation programs in the country, including a renowned lung transplantation program. Today we’re talking about the latest advances in lung transplant. My guest is Dr. Rade Tomic. He’s an associate professor of medicine in pulmonary and critical care at Northwestern Medicine. Dr. Tomic, what a pleasure to have you join us today. How common is lung transplant? And please tell us a little bit about your hospital history with lung transplants. Your team recently celebrated a major milestone—five years of lung transplantation at Northwestern Medicine. Share a little bit about what this milestone means to you and your team.
Rade Tomic MD (Guest): It was excellent opportunity to celebrate this wonderful milestone with our patients and to celebrate all the achievements that we have over the last five years. We really feel proud and honored to be a part of this life changing experience for many of our patients. The event was particularly special because the majority of the patients that were there, so we were able to share a lot of fond memories with our patients.
Host: Well then give us some disease processes that would necessitate lung transplantations and indications for referral to a transplant center.
Dr. Tomic: So one of the most common indications for the lung transplant is interstitial lung diseases. Probably around 50% of all lung transplants are done for interstitial lung diseases. When the patient needs oxygen with ambulation, it’s probably about time to refer a patient to the lung transplant center. Second most frequent indication for a lung transplant is COPD. These patients, as they progress over time, the only therapy that’s going to improve the quality of life and survival is actually the lung transplantation. The other indication for the lung transplant include cystic fibrosis, pulmonary hypertension, etcetera.
Host: Then what makes Northwestern Medicine’s lung transplant program stand apart? Tell us what’s so unique about this program.
Dr. Tomic: We try to integrate the world class research into our world class clinical care. Some of the features that, I think, is a notable achievement in our programs that we have one of the shortest waiting time for the lung transplantation in the United States. We never had any patient die on the lung transplantation wait list over the last five years. Where the average mortality on the wait list is between the 10 to 15% of the patients. We also able to do the lung transplant evaluation in five days, which is great opportunity for timely lung transplantation follow up patients.
Host: Well then along those lines tell us about some of the new and exciting research happening in the Northwestern Medicine lung transplantation program. What are some current advances that we should know about?
Dr. Tomic: We are currently working on the research that will enable us to decrease the use of the strong immunosuppression medications after the lung transplant. First results in experimental models are very promising. Also, we are trying to find ways how to decrease the incidents of primary graft dysfunction after the lung transplant. The primary graft dysfunction being the major cause of mortality early after the lung transplant is very important for all of our patients. We’re working also on many other projects which are very exciting. One of them is we are using photopheresis as a treatment for the patients with chronic rejection as a part of the national clinical trial. We are trying to find a new way of how to treat the chronic rejection.
Host: That is exciting. Expand a little more. You mentioned photopheresis. What are some of the most innovative technologies that are supporting your work in research?
Dr. Tomic: So photopheresis is a unique approach how to treat rejection which is derived in the heart transplant. The blood of the patient is exposed to the light and it seems that that will help to decrease progression or chronic rejection. Another very exciting new technology which we are trying to integrate in our clinical care is the ex vivo lung perfusion. This technology enables us to ventilate and perfuse the newly procured lungs so there is no anymore ischemia time. It’s already shown in the clinical trial that this new technology can improve the short term outcomes and long term outcomes after the lung transplantation. It will also increase the donor pool because it will enable us to observe the procured lungs for longer periods of time to see if they can be transplanted. It’s also a terrific platform for potential research where we can try to improve the function of the procured lungs prior to implantation to the recipients.
Host: Isn’t that amazing. Technology. Dr. Tomic, tell us a little bit about the five day evaluation program and how that benefits patients. What's involved in your pre-transplantation evaluation?
Dr. Tomic: So the five day program consists of a lot of teaching about the lung transplant, and the patient have opportunity and their family to understand all the particular details that lung transplant involves. It also includes a lot of testing. So we are evaluating patient for many different conditions. We are checking the patient’s heart, doing angiogram, doing gastrointestinal testing, etcetera. I think the primary benefit is the follow up patient that can be transplanted in appropriate time because we are not losing a lot of time in evaluation. The patient, pretty much, one week after evaluation is done will know if they are a candidate or not candidate and they can go on the list.
The second benefit for the patient is very early they will understand if the lung transplant is the option for them or not. They can decide how they want to proceed from there. The third benefit is that the referring physician will know also very quickly if the lung transplant is the option for their patient, and then plan accordingly if he wants to pay attention with some other therapeutic options and etcetera.
Host: Dr. Tomic, as we wrap up and discuss some of the latest exciting research in lung transplant, what are some of the challenges or constraint do you see in lung transplantation and in the future. Is this determined by an ongoing shortage of donor organs? Has it fueled a search for alternative therapies for failing lungs? Wrap it up for us and tell us what you see are some of the challenges and some of the successes.
Dr. Tomic: So the biggest challenge is [inaudible]. There is definitely a shortage organ and the lungs are very scarce resource for our patients. The other big challenge which is present for the last couple of decades in the lung transplantation world is the chronic rejection where we don’t have adequate treatment option. However, we are studying, and we are trying new medication for that condition. The progress that it’s achieved, I believe that new technology such as ex vivo lung profusion will cause significant benefit for the patient and elimination of ischemia time will be extremely helpful and there is really strong indications that the patient’s outcomes will improve. As we are transplanting the sicker patients than before, that’s certainly challenge for the post-operative course. However, with improvement in critical care, technology, and medicine, we see that even with the sicker patients we can achieve quite well results and comparative results to the less sick patients. So I believe that the new research on the chronic rejection and new technology will improve the outcomes for the patients after the lung transplant. I think this is a very exciting time because a lot of resources are devoted to the research and the lung transplant area and the new promising technology.
Host: Thank you so much Dr. Tomic for coming on today and sharing your incredible expertise. What a fascinating topic. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. For more information on the latest advances in medicine, please visit nm.org to get connected with one of our providers. If you found this podcast s informative as I did, please share on social media. Share with other providers and be sure not to miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.
Promising Technology and Research in Lung Transplantation
Melanie Cole, MS (Host): Northwestern Medicine has one of the premier organ transplantation programs in the country, including a renowned lung transplantation program. Today we’re talking about the latest advances in lung transplant. My guest is Dr. Rade Tomic. He’s an associate professor of medicine in pulmonary and critical care at Northwestern Medicine. Dr. Tomic, what a pleasure to have you join us today. How common is lung transplant? And please tell us a little bit about your hospital history with lung transplants. Your team recently celebrated a major milestone—five years of lung transplantation at Northwestern Medicine. Share a little bit about what this milestone means to you and your team.
Rade Tomic MD (Guest): It was excellent opportunity to celebrate this wonderful milestone with our patients and to celebrate all the achievements that we have over the last five years. We really feel proud and honored to be a part of this life changing experience for many of our patients. The event was particularly special because the majority of the patients that were there, so we were able to share a lot of fond memories with our patients.
Host: Well then give us some disease processes that would necessitate lung transplantations and indications for referral to a transplant center.
Dr. Tomic: So one of the most common indications for the lung transplant is interstitial lung diseases. Probably around 50% of all lung transplants are done for interstitial lung diseases. When the patient needs oxygen with ambulation, it’s probably about time to refer a patient to the lung transplant center. Second most frequent indication for a lung transplant is COPD. These patients, as they progress over time, the only therapy that’s going to improve the quality of life and survival is actually the lung transplantation. The other indication for the lung transplant include cystic fibrosis, pulmonary hypertension, etcetera.
Host: Then what makes Northwestern Medicine’s lung transplant program stand apart? Tell us what’s so unique about this program.
Dr. Tomic: We try to integrate the world class research into our world class clinical care. Some of the features that, I think, is a notable achievement in our programs that we have one of the shortest waiting time for the lung transplantation in the United States. We never had any patient die on the lung transplantation wait list over the last five years. Where the average mortality on the wait list is between the 10 to 15% of the patients. We also able to do the lung transplant evaluation in five days, which is great opportunity for timely lung transplantation follow up patients.
Host: Well then along those lines tell us about some of the new and exciting research happening in the Northwestern Medicine lung transplantation program. What are some current advances that we should know about?
Dr. Tomic: We are currently working on the research that will enable us to decrease the use of the strong immunosuppression medications after the lung transplant. First results in experimental models are very promising. Also, we are trying to find ways how to decrease the incidents of primary graft dysfunction after the lung transplant. The primary graft dysfunction being the major cause of mortality early after the lung transplant is very important for all of our patients. We’re working also on many other projects which are very exciting. One of them is we are using photopheresis as a treatment for the patients with chronic rejection as a part of the national clinical trial. We are trying to find a new way of how to treat the chronic rejection.
Host: That is exciting. Expand a little more. You mentioned photopheresis. What are some of the most innovative technologies that are supporting your work in research?
Dr. Tomic: So photopheresis is a unique approach how to treat rejection which is derived in the heart transplant. The blood of the patient is exposed to the light and it seems that that will help to decrease progression or chronic rejection. Another very exciting new technology which we are trying to integrate in our clinical care is the ex vivo lung perfusion. This technology enables us to ventilate and perfuse the newly procured lungs so there is no anymore ischemia time. It’s already shown in the clinical trial that this new technology can improve the short term outcomes and long term outcomes after the lung transplantation. It will also increase the donor pool because it will enable us to observe the procured lungs for longer periods of time to see if they can be transplanted. It’s also a terrific platform for potential research where we can try to improve the function of the procured lungs prior to implantation to the recipients.
Host: Isn’t that amazing. Technology. Dr. Tomic, tell us a little bit about the five day evaluation program and how that benefits patients. What's involved in your pre-transplantation evaluation?
Dr. Tomic: So the five day program consists of a lot of teaching about the lung transplant, and the patient have opportunity and their family to understand all the particular details that lung transplant involves. It also includes a lot of testing. So we are evaluating patient for many different conditions. We are checking the patient’s heart, doing angiogram, doing gastrointestinal testing, etcetera. I think the primary benefit is the follow up patient that can be transplanted in appropriate time because we are not losing a lot of time in evaluation. The patient, pretty much, one week after evaluation is done will know if they are a candidate or not candidate and they can go on the list.
The second benefit for the patient is very early they will understand if the lung transplant is the option for them or not. They can decide how they want to proceed from there. The third benefit is that the referring physician will know also very quickly if the lung transplant is the option for their patient, and then plan accordingly if he wants to pay attention with some other therapeutic options and etcetera.
Host: Dr. Tomic, as we wrap up and discuss some of the latest exciting research in lung transplant, what are some of the challenges or constraint do you see in lung transplantation and in the future. Is this determined by an ongoing shortage of donor organs? Has it fueled a search for alternative therapies for failing lungs? Wrap it up for us and tell us what you see are some of the challenges and some of the successes.
Dr. Tomic: So the biggest challenge is [inaudible]. There is definitely a shortage organ and the lungs are very scarce resource for our patients. The other big challenge which is present for the last couple of decades in the lung transplantation world is the chronic rejection where we don’t have adequate treatment option. However, we are studying, and we are trying new medication for that condition. The progress that it’s achieved, I believe that new technology such as ex vivo lung profusion will cause significant benefit for the patient and elimination of ischemia time will be extremely helpful and there is really strong indications that the patient’s outcomes will improve. As we are transplanting the sicker patients than before, that’s certainly challenge for the post-operative course. However, with improvement in critical care, technology, and medicine, we see that even with the sicker patients we can achieve quite well results and comparative results to the less sick patients. So I believe that the new research on the chronic rejection and new technology will improve the outcomes for the patients after the lung transplant. I think this is a very exciting time because a lot of resources are devoted to the research and the lung transplant area and the new promising technology.
Host: Thank you so much Dr. Tomic for coming on today and sharing your incredible expertise. What a fascinating topic. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. For more information on the latest advances in medicine, please visit nm.org to get connected with one of our providers. If you found this podcast s informative as I did, please share on social media. Share with other providers and be sure not to miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.