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Cardiovascular Report - Myth-Busting Lung Transplantation

Cardiovascular Report Fall 2009

Myth-Busting Lung Transplantation

Date: October 15, 2009

Ashish Shah
A key advantage with double-lung transplants, says Ashish Shah, is that residual disease is not left behind in the spared lung.

By the 1990s, enough of the immunosuppressant and technical challenges had been conquered to make lung transplantation a viable option for high-risk patients with pulmonary fibrosis. And while Ashish Shah is careful to note that it’s disingenuous to say lung transplantation is the perfect treatment for patients with end-stage lung disease, he’s hopeful.

That optimism is part experience, part diving into data from the United Network for Organ Sharing (UNOS), which makes information about 10,000 patients in the United States available to researchers.

“The power of these big data sets that yield big subsets is huge,” says Shah, surgical director of lung transplantation at Johns Hopkins. “We no longer have to rely on single-center research and are able to ask important questions about the biology of this procedure.”

Conducting a detailed review of the patient records for all single- and double-lung transplants performed in the United States and Canada from 1987 to 1997 has enabled the Johns Hopkins researchers to challenge some of the major prevailing myths.

First among these myths is the long-held assumption that double-lung transplants are riskier, especially among older, sicker patients. Not necessarily, says Shah. In fact, double-lung transplants improve outcomes in the sickest patients. Moreover, when both lungs are replaced, the new lungs, which must breathe together as a pair, are already adapted to each other.

Another myth? Double lung transplants are too complex an operation for an elderly patient. Again, says Shah, not so fast.

“Through our analysis of the UNOS database, we’ve discovered that double and single-lung transplant patients over age 60 have the same short term and intermediate survival rate,” he explains. In addition, having a double-lung transplant seems to be a contributing factor for patients who have survived for 10 years.

But the data needs to be mined for more gems of information. For example, Shah and his colleagues are interested in knowing why some patients may survive a decade after receiving a lung transplant while others may not. Why do some patients quickly reject the new lung or set of lungs? It’s clear that the biology of transplanted lungs is far more complex than that of other solid organs

“We’re at the end of the beginning of a maturing field,” Shah says. “We haven’t yet seen full maturity in our understanding and practices, which makes it exciting and a little frightening at the same time.”

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