UCSF Adult Lung Transplant Program Ranked Highest for Patient Survival

UCSF Medical Center has the highest one-year survival rate in the nation, among institutions performing more than 20 adult lung transplants each year, according to data from the Scientific Registry of Transplant Recipients (SRTR), a national database of transplant statistics.

The most recently released statistics reviewed lung transplant outcomes from July 2010 through December 2012. Based on 104 adult lung transplants, 96 percent of patients treated at UCSF Medical Center were still alive one year after surgery. The expected rate nationally is 84 percent.

UCSF Medical Center also is the only program to have achieved significantly better than expected outcomes for two consecutive report cycles from SRTR.

“We don’t shy away from complex cases. Pushing the boundaries is how we develop our expertise,” said Steven Hays, MD, medical director of the UCSF Lung Transplant Program. UCSF Medical Center performs between 40-50 adult lung transplants annually.

Challenging Work

Lung transplants can be among the riskiest transplant procedures, according to Jasleen Kukreja, MD, program and surgical director of the UCSF Lung Transplantation Program.

The surface area of a person’s lungs constantly is exposed to potential airborne pathogens or toxins, which can make it harder to care for a lung transplant patient than a kidney or even a heart transplant patient.

The high survival rate is especially meaningful, since UCSF takes care of some of the sickest patients. The hospital is unusual for its willingness to accept patients who have been turned away by other medical centers, as well as for its public mission to research new approaches to treatment and share the results with other institutions.

“We figure out what works for patients who come to us with complex issues, and we report our outcomes to the broader community in hopes that others may benefit. Over time, that’s how transplant medicine improves and transforms,” Hays said.

For example, UCSF pioneered the approach of using extracorporeal membrane oxygenation (ECMO) as a method to bridge patients who are dying of respiratory failure to lung transplant. ECMO provides cardiac and respiratory support to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their functions. The institution also pioneered successful implementation of lung transplantation for patients who are dying of lung disease related to autoimmune diseases such as scleroderma. 

“A major factor in our positive outcomes is the management of patients before, during and after their surgery coupled with long-term comprehensive monitoring” Kukreja said.  A team of experts, including nurses, pharmacists, physical therapists, dieticians, and social workers work closely with patients to prepare them for transplant including educating them about what to expect before, during, and, after surgery.

“When people get lung transplants at UCSF, they become our patients for life. After their transplant, patients come back regularly for appointments and, of course, a rigorous annual check up. We’ve spent the past 10 years refining our follow-up protocol with our patients and it has a huge impact on people’s long-term success,” said Hays.

Chronic rejection remains an issue for all lung transplant patients, though new protocols are pushing long-term survival rates higher. Currently, more than 60 percent of lung transplant patients at UCSF make it past the five-year mark.

New Approaches to Organ Shortage

Approximately 20 percent of donated lungs are acceptable for transplant, creating a critical need for more healthy lungs. The majority of donated lungs come from brain-dead donors who have been on ventilators, which can damage the lungs or increase the odds of a lung infection.

Kukreja and her team at UCSF are participating in two international trials aimed at improving the function of donated lungs prior to transplant. In the study, donated lungs are put on a type of heart-lung machine that pumps them full of blood and antibiotics to ward off infection as well as to supply them with oxygen. UCSF has performed seven transplants with lungs maintained this way, and all seven patients are doing well.

According to Kukreja, this new approach could significantly increase the donor pool, which will reduce waiting time on the list and save lives. These “breathing lungs” may even prove to work better than lungs that are treated in the “normal” way, meaning they are put on ice without oxygen or blood before transplant so the research has the potential to set a new precedent for the standard of care.

“Restoring a person’s ability to breathe is one of the most satisfying parts of my job,” she said. “After transplant, they send me photos, postcards from vacations where they are skiing, rock climbing, surfing, jogging, and biking. Lung transplant patients are keenly aware that they’ve been given a second chance at life, and they don’t want to waste a single second.”

The SRTR, founded in 1987, supports ongoing evaluation of the scientific and clinical status of solid organ transplantation, including kidney, heart, liver, lung, intestine, and pancreas. Data in the registry are collected by the Organ Procurement and Transplantation Network (OPTN) from hospitals and organ procurement organizations across the country. SRTR data on UCSF lung transplant outcomes can be found on the SRTR website.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.

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