Clinical
Briefing: Penn Lung Transplant Update, 2006
November/December 2006
Advanced Lung Disease Program
In 2005, the United
Network for Organ Sharing (UNOS) implemented the Lung Allocation
Score (LAS) System, which changed how lungs are assigned
to patients. LAS uses medical data, transplant benefit and
transplant urgency to calculate a score. Donor/recipient
ABO compatibility and size match remain the primary determinants
for allocation.
Disease Distribution Prior To And
After Lung Allocation Scoring
System Implementation |
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Source: UPHS Clinical Outcomes Database
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Penn's waiting list has a large number of high-risk patients with high LAS scores. Previously, high-risk patients would have died waiting on the list. Now patients have the opportunity to receive a life saving lung transplant in a timely manner.
Lung Transplants 2005 National |
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Source: Data from OPTN/SRTR Center and OPO specific reports (January 2006)
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"Penn is one of the largest adult lung transplant
programs, ranking fourth in the the United
States. Our surgeons performed 59 lung transplants
in 2005. Our 1- and 3-year survival rates of
87 percent and 68 percent* are among the highest
in the nation and consistently exceed national
averages."
Alberto
Pochettino, MD, Surgical Director
Lung Transplantation Program |
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Case Study
Patient B.G. is a 66-year-old man with advanced lung disease secondary to
idiopathic pulmonary fibrosis. His lung disease progressed despite aggressive
treatment with corticosteroids and cyclophosphamide. In July 2004,
he underwent evaluation and was listed for left single lung transplantation.
Over
the next two years, while awaiting lung transplantation,
his clinical status slowly deteriorated. By May 2005, both forced vital capacity (FVC)
and total lung capacity (TLC) were severely reduced at 33 percent of predicted.
During a six minute walk test, the patient ambulated 1,072 feet and desaturated
to a Sp02 of 80 percent while receiving 100 percent oxygen via non-rebreather
mask. These factors yielded a very high LAS (90.4) and placed him atop
the waiting list.
On November 1, 2005 the patient developed impending respiratory
failure requiring evaluation in the emergency room. A
donor lung became available the following day. The
patient underwent left single lung transplantation in an
uncomplicated procedure that lasted four hours. Almost immediately
after transplantation, the patient reported resolving dyspnea. He
spent 48 hours in the surgical intensive care unit and was
transferred to the floor for optimization of anti-rejection
medication, initiation of physical therapy and pulmonary
rehabilitation.
After a total of 11 days in the hospital,
he was discharged to home in good physical condition. Four
months later, the patient reports an excellent quality of
life. He is off supplemental oxygen and recently returned
from a two-week cruise. Forced vital capacity has
improved to 68 percent of predicted and the allograft is
clear.
Our Team of Faculty
The Lung Transplantation Program at the University of Pennsylvania Health System is one of the most experienced programs in the country. Since its inception in 1991, the program has established itself among the premier centers both regionally and nationally. The Transplant Team at Penn is now approaching its 500th lung transplant.
Lung Transplant Surgeons
Alberto Pochettino, MD
Associate Professor of Surgery
Surgical Director,
Lung Transplantation Program
Joseph E. Bavaria, MD
Brooke Roberts-William Maul
Measey Professor of Surgery
Wilson Y. Szeto, MD
Assistant Professor of Surgery
Y. Joseph Woo, MD
Assistant Professor of Surgery
Associate Surgical Director,
Thoracic Transplantation Program
Pulmonologists
Vivek Ahya, MD
Assistant Professor of Medicine
Medical Director,
Lung Transplantation Program
Robert M. Kotloff, MD
Craig and Elaine Dobbin and
Nancy P. Blumenthal Professor
Chief, Section of Advanced Lung Disease and Lung Transplantation
Jason Christie, MD
Assistant Professor of Medicine
Denis Hadjiliadis, MD
Assistant Professor of Medicine
Associate Medical Director,
Lung Transplantation Program
Jeffrey S. Sager, MD
Assistant Professor of Medicine
Associate Medical Director,
Lung Transplantation Program
Lung Transplant Nurse
Practitioners and Specialists
Nancy Blumenthal, MSN, CRNP
Kevin Carney, RN
Diane Isaia, MS, CRNP
James Mendez, MSN, CRNP
Social Work
Regina Miller, MSW
Financial Coordinator
Michelle Roberts
Advance Lung Disease Specialists
Michael P. Casey, MD
Clinical Associate Professor of Medicine
Chief, Section of Pulmonary
Medicine, Pennsylvania Hospital
Joel D. Cooper, MD
Chief, Division of Thoracic Surgery,
University of Pennsylvania
Health System
Director, Obstructive Lung
Disease Program
John H. Hansen-Flaschen, MD
Professor of Medicine
Chief, Pulmonary, Allergy and
Critical Care, Hospital of the
University of Pennsylvania
David A. Lipson, MD
Assistant Professor of Medicine
Director, Cystic Fibrosis Program
Medical Director, Obstructive Lung
Disease Program
Harold L. Palevsky
Professor of Medicine
Chief, Pulmonary, Allergy and
Critical Care, Penn Presbyterian Medical Center
Director, Pulmonary Vascular
Disease Program
Milton D. Rossman, MD
Professor of Medicine
Director, Interstitial Lung Disease Program
Morris A. Swartz, MD
Clinical Associate Professor of Medicine
Medical Director, Respiratory Care and Pulmonary Diagnostic Services
Penn Presbyterian Medical Center
Access
Patient appointments are available at:
Hospital of the University of Pennsylvania
Ground Rhoads Transplant Clinic
36th Street and Hamilton Walk
Philadelphia, PA 19104
Phone: 215-662-2366
Fax: 215-349-8235
Hospital
of the University of Pennsylvania
Silverstein Pavilion
Fourth Floor
3400 Spruce Street
Philadelphia, PA 19104
Hospital
of the University of Pennsylvania
Ravdin Building
Third Floor
3400 Spruce Street
Philadelphia, PA 19104
Penn Presbyterian Medical Center
Ground Floor-Rear
Philadelphia Heart Institute
39th and Market Streets
Philadelphia, PA 19104
Pennsylvania Hospital
700 Spruce Street
Suite 500
Philadelphia, PA 19107
To refer a patient and/or consult with a doctor:
Please contact your UPHS physician liaison with any concerns or problems you may experience when referring your patient.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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