Lung Transplant - Patient Focused
Dr. Sravanthi Nandavaram and Dr. Maher Baz discuss patient-focused lung transplants and care at UK Health.
Featured Speakers:
Learn more about Maher Baz, MD
Sravanthi Nandavaram, MD specialties include Cardiothoracic Surgery Transplant - Lung.
Learn more about Sravanthi Nandavaram, MD
Maher Baz, MD | Sravanthi Nandavaram, MD
Maher Baz is the Medical Director of the Lung Transplant Program. He attended college and medical school at the American University of Beirut in Lebanon and then completed an internal medicine residency at Duke University Medical Center. Dr. Baz then completed a Critical Care and Pulmonary Medicine fellowship at Duke University as well.Learn more about Maher Baz, MD
Sravanthi Nandavaram, MD specialties include Cardiothoracic Surgery Transplant - Lung.
Learn more about Sravanthi Nandavaram, MD
Transcription:
Lung Transplant - Patient Focused
Introduction: Another informational resource from UK Healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome. This is UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole. Today we're talking about lung transplant at UK Health. Joining me is Dr. Sravanthi Nandavaram. She's a Transplant Pulmonologist and Dr. Maher Baz, he's the Medical Director of Lung Transplant and they're both at UK Healthcare. Dr. Nandavaram, I'd like to start with you. Tell us how common is a lung transplant? How many are performed on a yearly basis? Tell us a little bit about this incredible procedure.
Dr. Nandavaram: Lung transplant is one of the treatment options for patients with end stage lung disease for whom the medical diseases irreversible. The first lung transplant was started in 1963. And at UK here, the first lung transplant happened in 1991. Since then, there has been a steady rise in the number of transplants that we have been performing and in the last five years we have been doing anywhere between 25 to 30 transplants a year. There has been a steady rise in the last two decades and becoming one of the common treatment options for patients with irreversible end stage lung disease. And we have performed about 425 transplants since 1991 here at UK. And in the last year in 2019, we performed about 29 transplants between January and December of 2019.
Host: Well that's certainly amazing. And Dr. Baz, tell us how you've seen this evolve over the years and what's changed from 20 years ago to what you're doing now?
Dr. Baz: I would like to add one note to the number of transplants and then I will walk you through a little bit what has changed. So there's about 2000 total lung transplants in America about 2000 a year. You have to compare it to kidney transplants about 18 or 20,000 a year. And part of the disparity is there is much less lungs that we can retrieve from donors that donate because of the pneumonia on the lungs and the fluid overload and the smoking compared to the kidney donation from the same donor. As far as how things have changed in the 80s, actually in the 70s and early eighties when they were doing transplants. The immunosuppression was mostly steroids, prednisone and Imuran. And they were having a lot of problems with wound healing. Things were breaking down and wound healing because the prednisone does not allow wound healing. And then in the early eighties, cyclosporine came along and they started doing very low doses of prednisone. And that was an amazing difference in wound healing patients making out of the hospital. No more, no more sutures breaking down.
And then with time, as we did more and more transplants in the eighties into the nineties, we realized as they get few years out, there's chronic lung rejection that's problem few years later. And that changed the thinking in the transplant world that maybe we should do two lungs in. most people, compared to one lung, so they'll have a little bit more lung reserve. So if chronic rejection happens, few years later, they'll have a little bit more than lung reserve to support them. So two things have changed really in the last 30 years is cyclosporine and it's cousin program was introduced less prednisone, better wound healing patients, make it out of the hospital. And then we recognized this rejection as they started making out of the hospital years later. More people lean toward two lungs compared to one lung to support them through it. And the last thing is more and more research being done and how do we treat rejection, chronic lung rejection to keep the lungs steady and keep them healthy years later.
Host: What a fascinating topic we're speaking about today for patients and Dr. Nandavaram, who qualifies for a transplant? And while you're speaking of that, speak about some of the conditions that eventually lead to transplant and when that becomes the discussion that you have with patients?
Dr. Nandavaram: So as I mentioned before, anyone that end stage irreversible lung disease needs to be evaluated for lung transplant. And when I say irreversible lung disease, some of the conditions would be like very severe COPD or emphysema, pulmonary fibrosis, any other interstitial lung disease which is irreversible, pulmonary hypertension or anyone with other rare pulmonary diseases or occupational lung disease like coal workers, pneumoconiosis which we see in Kentucky all the time, or silicosis. Any kind of such occupational lung disease which is irreversible, or cystic fibrosis or any other non cystic fibrosis bronchiectasis. These are all the conditions which are irreversible and patients need to be evaluated for lung transplant. And lung transplant is a very complex surgery, and we do a thorough comprehensive evaluation, as well as each and every organ system to see if a patient will be eligible for the surgery, so that they have the benefits of the surgery. And with the lung transplant, we are ensuring that patient lives longer and they have a better quality of life after the lung transplant.
Host: Dr. Baz, what can a patient expect at the University of Kentucky Healthcare once they've been placed on the transplant list through procedure and following? Tell us about that wait-list experience and how that's calculated and what they can expect when they're part of this program.
Dr. Baz: First, they should expect that we are a team. We are all on the same team. Compassionate, friendly we try to explain everything as we go along. And the team concept is to keep them on their feet, as healthy as possible, as strong as possible in preparation for transplant. Cause there's usually a period of weeks if we're lucky, but often several, you know, few to several months waiting time. So staying healthy, saving that muscle strength, frequent clinic visits is a routine and every clinic visit is a opportunity for us to communicate with the patients, educate the patient, and develop that bond because they have to have a trusting relationship going into such a big surgery.
Host: Expand a little more on your multidisciplinary approach Dr. Baz, who's involved on your team?
Dr. Baz: First to get patients listed, they have to go through tests, which includes like a heart catheterization, CT scans, but also they'll meet all our team members, which are our financial team, our social worker, our physical therapists, those are key part of, you know, the patient's wellbeing and for us to get to know the patients better. And as we list them, they see us periodically in clinic and often they'll see our physical therapists with us in clinic to make sure their muscle strength is staying steady. And our social worker, make sure, you know, we problem solve all issues before we get the surgery. And obviously part of our team also is our nurse coordinators who get to know the patients and our thoracic transplant surgeons are also key part of our team.
Host: Dr. Nandavaram, tell us a little bit about recovery time after the lung transplant. What kind of lifestyle changes does a patient need to make? What kind of support groups do you have available? Speak about life after the transplant.
Dr. Nandavaram: So after the surgery, the usual hospital stay to recover from the surgery is about two to three weeks. Where patients spend about three to five days in the ICU and then they're on the regular floor thereafter. And during this time we are making sure they're recovering well from the surgery. Their incision is healing, making sure they're tolerating their pills, making sure that they're getting their muscle strength back. And once they are discharged from the hospital we usually have our patients live locally for about a month. Again to ensure everything is going well in terms of healing, making sure they're not having any infections, and we see them once a week at the clinic. And thereafter they come and see us once a month in the clinic. Again to make sure everything is going well. Apart from that in their personal lifestyle, patients will come off the oxygen because before the transplant they had end stage lung disease where in they have been requiring oxygen, and once we transplant these patients they will come off of the oxygen so they won't need the oxygen.
There symptoms of shortness of breath or cough will be gone and they'll be able to do more in terms of their physical or functional activity at home. Usually patients will have some restrictions within the first three to four months in terms of driving or lifting heavy weights. And that's basically to ensure that the incision is healing well and so that they won't have any problems from incisions perspective. But usually after five to six months, usually patients go back to work. As long as it's not too heavy lifting or anything. Patients go back to their physical activity, patients go back to their gym or rehab. So usually they go back to their previous life within like four to six months after the surgery and whatever they are able to do. And if we talk about the restrictions of post transplant patients should be following, one would be to make sure that they are doing their safety measures. One would be that they are not around sick people, and we usually tell them to avoid crowded places because these patients are on anti-rejection medications, which is going to suppress their immune system.
So they are at risk for infections. So basically we give them the general instructions to avoid or stay away from sick people or stay away from crowded places. And when it comes to food, usually there are not much restrictions as long as again, they know where they're eating from and they're making sure that there is food hygiene and sometimes there are certain things that might alter their blood work because of their medications that they are on. So sometimes they might have some restrictions, but these are all like usually temporary minor restrictions on the food. So overall, almost every patient will go back to their previous usual life wherein they're performing every physical activity, enjoying their life, doing whatever their interests are after the transplant usually, within four to six months after the transplant, we do have patients who went back to work. We do have patients who go on trips and as long as they take certain safety measures, they all do well.
Host: And Dr. Baz, would you wrap up for us why someone should come to UK for this type of care? Tell us really your best advice about lung transplant for patients that might qualify
Dr. Baz: In general, consider a transplant, especially if you have certain diseases like cold worker's lung, black lung, pulmonary fibrosis, cystic fibrosis because transplant can be a life-prolonging procedure in those diseases because they get to a point where survival becomes limited in those diseases. The smoker's lung, the COPD lung, we can get to a point where transplant improves their quality of life. All these patients should be considering it, many to improve their survival and all of them to improve the quality of life. Under the quality of life is not only they can get off oxygen and have better lung capacity, but many people who have advanced lung diseases have a underlying what I call appropriate situational anxiety and depression. Because they're limited with the activities. So their social circle is very, is very small. And if they have more lung function after transplant, they're more active, bigger social circle.
Their outlook on life really improves. As far as specifically to UK, I think we are compassionate. I think we have patient friendly program and between our surgeons and our medical team. I mean we have probably 50 year in experience among the three of us, if you add them up. So that is the transplant in general and why they should come to UK. And our outcomes are excellent, our one of your outcomes are excellent above the national average.
Dr. Nandavaram: Also we have the facility of using ECMO as a bridge to transplant and UK is a center of excellence for ECMO wherein if the patient is decompensated while waiting for the lungs, we can put them on ECMO, which is a heart lung machine while the patient is waiting for lungs. So we have that facility do and we have been doing, so that's addition to the program and that way we can get people transplanted rather than people dying on the list waiting for the lungs.
Host: Thank you Doctors so much for coming on and sharing your incredible expertise in this fascinating topic. That concludes another episode of UK HealthCast with the University of Kentucky Healthcare. To find out more information about the lung transplant program, please visit our website at ukhealthcare.uky.edu to get connected with one of our providers. Please remember also to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. For more health tips and updates, follow us on your social channels. I'm Melanie Cole.
Lung Transplant - Patient Focused
Introduction: Another informational resource from UK Healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.
Melanie Cole: Welcome. This is UK HealthCast with the University of Kentucky Healthcare. I'm Melanie Cole. Today we're talking about lung transplant at UK Health. Joining me is Dr. Sravanthi Nandavaram. She's a Transplant Pulmonologist and Dr. Maher Baz, he's the Medical Director of Lung Transplant and they're both at UK Healthcare. Dr. Nandavaram, I'd like to start with you. Tell us how common is a lung transplant? How many are performed on a yearly basis? Tell us a little bit about this incredible procedure.
Dr. Nandavaram: Lung transplant is one of the treatment options for patients with end stage lung disease for whom the medical diseases irreversible. The first lung transplant was started in 1963. And at UK here, the first lung transplant happened in 1991. Since then, there has been a steady rise in the number of transplants that we have been performing and in the last five years we have been doing anywhere between 25 to 30 transplants a year. There has been a steady rise in the last two decades and becoming one of the common treatment options for patients with irreversible end stage lung disease. And we have performed about 425 transplants since 1991 here at UK. And in the last year in 2019, we performed about 29 transplants between January and December of 2019.
Host: Well that's certainly amazing. And Dr. Baz, tell us how you've seen this evolve over the years and what's changed from 20 years ago to what you're doing now?
Dr. Baz: I would like to add one note to the number of transplants and then I will walk you through a little bit what has changed. So there's about 2000 total lung transplants in America about 2000 a year. You have to compare it to kidney transplants about 18 or 20,000 a year. And part of the disparity is there is much less lungs that we can retrieve from donors that donate because of the pneumonia on the lungs and the fluid overload and the smoking compared to the kidney donation from the same donor. As far as how things have changed in the 80s, actually in the 70s and early eighties when they were doing transplants. The immunosuppression was mostly steroids, prednisone and Imuran. And they were having a lot of problems with wound healing. Things were breaking down and wound healing because the prednisone does not allow wound healing. And then in the early eighties, cyclosporine came along and they started doing very low doses of prednisone. And that was an amazing difference in wound healing patients making out of the hospital. No more, no more sutures breaking down.
And then with time, as we did more and more transplants in the eighties into the nineties, we realized as they get few years out, there's chronic lung rejection that's problem few years later. And that changed the thinking in the transplant world that maybe we should do two lungs in. most people, compared to one lung, so they'll have a little bit more lung reserve. So if chronic rejection happens, few years later, they'll have a little bit more than lung reserve to support them. So two things have changed really in the last 30 years is cyclosporine and it's cousin program was introduced less prednisone, better wound healing patients, make it out of the hospital. And then we recognized this rejection as they started making out of the hospital years later. More people lean toward two lungs compared to one lung to support them through it. And the last thing is more and more research being done and how do we treat rejection, chronic lung rejection to keep the lungs steady and keep them healthy years later.
Host: What a fascinating topic we're speaking about today for patients and Dr. Nandavaram, who qualifies for a transplant? And while you're speaking of that, speak about some of the conditions that eventually lead to transplant and when that becomes the discussion that you have with patients?
Dr. Nandavaram: So as I mentioned before, anyone that end stage irreversible lung disease needs to be evaluated for lung transplant. And when I say irreversible lung disease, some of the conditions would be like very severe COPD or emphysema, pulmonary fibrosis, any other interstitial lung disease which is irreversible, pulmonary hypertension or anyone with other rare pulmonary diseases or occupational lung disease like coal workers, pneumoconiosis which we see in Kentucky all the time, or silicosis. Any kind of such occupational lung disease which is irreversible, or cystic fibrosis or any other non cystic fibrosis bronchiectasis. These are all the conditions which are irreversible and patients need to be evaluated for lung transplant. And lung transplant is a very complex surgery, and we do a thorough comprehensive evaluation, as well as each and every organ system to see if a patient will be eligible for the surgery, so that they have the benefits of the surgery. And with the lung transplant, we are ensuring that patient lives longer and they have a better quality of life after the lung transplant.
Host: Dr. Baz, what can a patient expect at the University of Kentucky Healthcare once they've been placed on the transplant list through procedure and following? Tell us about that wait-list experience and how that's calculated and what they can expect when they're part of this program.
Dr. Baz: First, they should expect that we are a team. We are all on the same team. Compassionate, friendly we try to explain everything as we go along. And the team concept is to keep them on their feet, as healthy as possible, as strong as possible in preparation for transplant. Cause there's usually a period of weeks if we're lucky, but often several, you know, few to several months waiting time. So staying healthy, saving that muscle strength, frequent clinic visits is a routine and every clinic visit is a opportunity for us to communicate with the patients, educate the patient, and develop that bond because they have to have a trusting relationship going into such a big surgery.
Host: Expand a little more on your multidisciplinary approach Dr. Baz, who's involved on your team?
Dr. Baz: First to get patients listed, they have to go through tests, which includes like a heart catheterization, CT scans, but also they'll meet all our team members, which are our financial team, our social worker, our physical therapists, those are key part of, you know, the patient's wellbeing and for us to get to know the patients better. And as we list them, they see us periodically in clinic and often they'll see our physical therapists with us in clinic to make sure their muscle strength is staying steady. And our social worker, make sure, you know, we problem solve all issues before we get the surgery. And obviously part of our team also is our nurse coordinators who get to know the patients and our thoracic transplant surgeons are also key part of our team.
Host: Dr. Nandavaram, tell us a little bit about recovery time after the lung transplant. What kind of lifestyle changes does a patient need to make? What kind of support groups do you have available? Speak about life after the transplant.
Dr. Nandavaram: So after the surgery, the usual hospital stay to recover from the surgery is about two to three weeks. Where patients spend about three to five days in the ICU and then they're on the regular floor thereafter. And during this time we are making sure they're recovering well from the surgery. Their incision is healing, making sure they're tolerating their pills, making sure that they're getting their muscle strength back. And once they are discharged from the hospital we usually have our patients live locally for about a month. Again to ensure everything is going well in terms of healing, making sure they're not having any infections, and we see them once a week at the clinic. And thereafter they come and see us once a month in the clinic. Again to make sure everything is going well. Apart from that in their personal lifestyle, patients will come off the oxygen because before the transplant they had end stage lung disease where in they have been requiring oxygen, and once we transplant these patients they will come off of the oxygen so they won't need the oxygen.
There symptoms of shortness of breath or cough will be gone and they'll be able to do more in terms of their physical or functional activity at home. Usually patients will have some restrictions within the first three to four months in terms of driving or lifting heavy weights. And that's basically to ensure that the incision is healing well and so that they won't have any problems from incisions perspective. But usually after five to six months, usually patients go back to work. As long as it's not too heavy lifting or anything. Patients go back to their physical activity, patients go back to their gym or rehab. So usually they go back to their previous life within like four to six months after the surgery and whatever they are able to do. And if we talk about the restrictions of post transplant patients should be following, one would be to make sure that they are doing their safety measures. One would be that they are not around sick people, and we usually tell them to avoid crowded places because these patients are on anti-rejection medications, which is going to suppress their immune system.
So they are at risk for infections. So basically we give them the general instructions to avoid or stay away from sick people or stay away from crowded places. And when it comes to food, usually there are not much restrictions as long as again, they know where they're eating from and they're making sure that there is food hygiene and sometimes there are certain things that might alter their blood work because of their medications that they are on. So sometimes they might have some restrictions, but these are all like usually temporary minor restrictions on the food. So overall, almost every patient will go back to their previous usual life wherein they're performing every physical activity, enjoying their life, doing whatever their interests are after the transplant usually, within four to six months after the transplant, we do have patients who went back to work. We do have patients who go on trips and as long as they take certain safety measures, they all do well.
Host: And Dr. Baz, would you wrap up for us why someone should come to UK for this type of care? Tell us really your best advice about lung transplant for patients that might qualify
Dr. Baz: In general, consider a transplant, especially if you have certain diseases like cold worker's lung, black lung, pulmonary fibrosis, cystic fibrosis because transplant can be a life-prolonging procedure in those diseases because they get to a point where survival becomes limited in those diseases. The smoker's lung, the COPD lung, we can get to a point where transplant improves their quality of life. All these patients should be considering it, many to improve their survival and all of them to improve the quality of life. Under the quality of life is not only they can get off oxygen and have better lung capacity, but many people who have advanced lung diseases have a underlying what I call appropriate situational anxiety and depression. Because they're limited with the activities. So their social circle is very, is very small. And if they have more lung function after transplant, they're more active, bigger social circle.
Their outlook on life really improves. As far as specifically to UK, I think we are compassionate. I think we have patient friendly program and between our surgeons and our medical team. I mean we have probably 50 year in experience among the three of us, if you add them up. So that is the transplant in general and why they should come to UK. And our outcomes are excellent, our one of your outcomes are excellent above the national average.
Dr. Nandavaram: Also we have the facility of using ECMO as a bridge to transplant and UK is a center of excellence for ECMO wherein if the patient is decompensated while waiting for the lungs, we can put them on ECMO, which is a heart lung machine while the patient is waiting for lungs. So we have that facility do and we have been doing, so that's addition to the program and that way we can get people transplanted rather than people dying on the list waiting for the lungs.
Host: Thank you Doctors so much for coming on and sharing your incredible expertise in this fascinating topic. That concludes another episode of UK HealthCast with the University of Kentucky Healthcare. To find out more information about the lung transplant program, please visit our website at ukhealthcare.uky.edu to get connected with one of our providers. Please remember also to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts. For more health tips and updates, follow us on your social channels. I'm Melanie Cole.