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My name is Ashish Shah, I’m an Assistant [now Associate] Professor of Surgery here at Johns Hopkins and the Surgical Director of Lung Transplantation. I provide full spectrum adult cardiac surgery, but my real focus is on lung transplantation.
The technique of lung transplantation has really been improved and almost perfected over the last ten years. And essentially, certainly here at Johns Hopkins, all the patients are brought to the operating room, an incision is made across their chest, for the most part. The heart and lungs are exposed. We remove one lung at a time, replace one lung at a time, and then close them up. It sounds very simple. It’s pretty straightforward from our standpoint, but it’s a very big operation. About a third of the time we will use the heart-lung machine in order to support the patient, but the majority of patients will be done without using the heart-lung machine.
Despite the very large incision, the scar is remarkably small. The incision goes below the breasts and comes across. It is very well hidden by clothing.
The quality of life after lung transplant is excellent, provided that the patient’s lungs are working very well. Keep in mind that before these operations, people with end-stage lung disease have a terrible quality of life. We have many patients who are unable to bathe themselves, patients who are really homebound and the promise of lung transplantation is not to live forever, but it is to restore quality of life. We know by surveys, for example, that over 90% of patients after lung transplant, will have no physical activity limitations or a small amount of limitations. That’s a vast improvement from where things were before the transplant. Now lung transplantation is an imperfect therapy, and people can have difficulties afterwards. If the new lungs are not working as well as they can be, that will impact quality of life. If you have complications from surgery or the antirejection medications, that can impact your quality of life. But the majority of patients have a vast improvement for quality of life from before the transplant.
One of our missions here is to provide and create new information, new knowledge, to improve this field. As I’ve said before, this is an imperfect therapy. There are issues that we still need to work on. One of the things that I do in my laboratory’s work on “How do we make these lungs work right out of the gates?” We hook up the lungs, we start ventilating them, and about 20% of the time, they don’t work quite well. Most of the time it works out okay, but sometimes it works out really badly and so one of the things that I’m focusing on is how do you protect new lungs and how do you make them work perfectly well right out of the gates. Because what we know is that if the lungs work well in the beginning, odds are the patient is going to do fine long term, years later. If they don’t work, we know that all bets are off, and you can have someone who does well or doesn’t do well. So how do we fix that? So in my laboratory we are looking at different ways to manipulate organs. That means use different medications, sometimes that means different techniques. We have a lot of other work here at Johns Hopkins that are involved with looking at how to protect patients from viral infections, which happens. Also looking at different ways to use medications to improve outcomes after lung transplant. So we have multiple laboratories here at Johns Hopkins that are working on different facets of the problem that we have in lung transplantation.
We started with a relatively small volume program. It was very conservative and have been able to put together – and this is really a team approach – a great team of people that now provide – I can say this easily – world class therapies for patients with end stage lung disease. We’ve been able to transplant successfully patients that we would otherwise have turned down five or six years ago. And I feel somewhat a part of that process: to gather this team together, to provide the services and the surgical expertise to let us do those things. But it really has been a project to get everybody on board with the idea of managing these patients, of having one goal and that is the success of the individual patient and that is, again all of these disciplines. Intensive care units, not just the surgical intensive care unit, but the medical intensive care units, our colleagues in general surgery, pulmonary critical care, physical therapy, pharmacy, nursing, respiratory therapy – all of these things, I’ve spent a lot of time on them in the last five years. To see a program now able to offer really advance therapies for patients is my proudest professional accomplishment.