Dr. Matthew Morrell, Medical Director of the UPMC Lung Transplant Program discusses the risk factors for advanced lung disease and steps individuals can take for better lung health. Dr. Morrell also discusses how and when transplant may become an option for patients.
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– [Host] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– The risk factors for advanced lung disease and steps you can take for better lung health. Welcome to the UPMC HealthBeat podcast. I’m Tonia Caruso, and joining us right now is Dr. Matthew Morrell. He’s the medical director of the UPMC Lung Transplant Program. Doctor, thanks so much for joining us.
– Thank you for having me.
– So let’s really begin by how do you define advanced lung disease?
– Advanced lung disease, by the terminology, usually means end-stage lung disease. These patients have had lung disease for a period of time to the point where they may have scarring on their lungs that really prevents their lungs from operating or functioning the way they should, and oftentimes usually are on supplemental oxygen or other inhalers or medications that they may be dependent upon in order to live and carry out their activities of daily living.
– So what are some of the risk factors of advanced lung disease?
– The biggest risk factor for advanced lung disease is tobacco use and cigarette smoking. Over time, cigarette smoke can cause destruction of the lung itself, which then impairs an individual’s ability to breathe in oxygen and breathe out carbon dioxide. Some individuals can develop advanced lung disease also from recurrent exposure to things in the environment that over time cause inflammation and scarring of the lungs. And finally, some patients actually can develop an inherited form of lung disease. For example, there are patients that have cystic fibrosis that are born with this disease, and over time, they develop a destruction of the lung and scarring that over time, they need oxygen and other medications to be able to function.
– And so who comes to see you? And I’m wondering, if they come to the transplant center, does that mean that’s where they are and they have to get a transplant, or are there other modes of treating patients?
– Well, we get a lot of referrals from a lot of community physicians who have been caring for patients with advanced lung disease that have really exhausted all of their options when it comes to medications and other therapies, to the point that the only thing that will allow these individuals to live and to function is a lung transplant. So a lot of these patients do come and see us and are evaluated. They go through a rigorous program and evaluation process in which they see individuals such as a surgeon, a pulmonologist, a social worker, a pharmacist, someone from finances, to really see if they qualify for a lung transplant to extend both the quantity of life and also quality of life. So we’re a very busy program. We’re actually the largest program in the United States. We recently transplanted, a couple of years ago, our 2,000th patient with a lung transplant. Right now, we’re anywhere between 2,100 and 2,200 lung transplants performed in total since the program started.
– And why is that important that you do so many lung transplants here compared to other institutions?
– Well, we’re a large program. We’re the oldest program in the United States. So as a result of that, we’ve been doing this for a while and we have a lot of experience. We have a lot of experience in terms of caring for patients with end-stage lung disease and also caring for these patients and helping them recover from some of the complications that can happen following lung transplant. As a result of this, we have a pretty good reputation. And one-third of the patients that we end up transplanting actually have been turned down at other centers here in the United States and possibly in the world for a lung transplant. So they’re referred to us, knowing that we have a good reputation and good experience in terms of dealing with some of these complications. And we, again, evaluate these patients and if they’re good candidates, put them on the wait list and then transplant them.
– And let’s talk more about that. So there is an extensive process. Who is typically a good candidate for a lung transplant, and how long, typically, is the waiting list?
– Most programs have a series of qualifications for lung transplant that may include age. We want to make sure that individuals don’t have other end-organ disease such as heart failure or being on dialysis. So there are pretty strict qualifications. In general, we like patients to have just their lung disease itself and no other significant other major medical problems. But what happens is patients, when we get their records and referral from the outside physician, they go through in a very intensive and invasive screening process to review the records and make sure there aren’t any contraindications, or things in regard to their medical history, that may prohibit them from getting a lung transplant. So the wait list can be very variable. Some patients may be on the wait list for only a couple of days, versus some individuals may need to be on the wait list for a lot longer, such as a couple months or even up to a year, waiting for a lung transplant. In general, this depends on how sick they are at the time of the lung transplant. When they are listed for lung transplant, they’re given something called a lung allocation score, which determines their priority on this wait list which they have. So some of the patients that may wait such a short period of time, sometimes they may be sick enough in which they need to stay in the hospital on lots of oxygen in order to survive and live waiting for a lung transplant.
– What is the surgery like? What is the recovery like?
– The surgery itself can last anywhere from five to six up to 12 or 14 hours. A lot of that depends upon how sick the patient is at the time of transplant. Some patients may need what we call support or intraoperative support, such as cardiopulmonary bypass, which is a heart-lung machine that helps keep their heart beating and their blood pumping throughout their body during the time of that transplant surgery. So when patients are on this machine, that may extend their time that they’re in their operating room. Now the recovery following the operation can be anywhere as short as seven to 10 days, or some patients may have complications right after surgery and sometimes may need to be in the hospital for a month, two months, or even three months following transplantation.
– And of course, people think about lung disease in this day and age, and COVID can often come to mind. Can you talk about what COVID does to the lungs in the body?
– Well, COVID is a virus, and just like some viruses and most bacteria, they can cause pneumonia, or inflammation and infection of the lung. And as that inflammation happens, the body’s response is to try to get rid of that virus and get rid of that infection and sometimes can lead to scarring and destruction of the lung structure itself. And if it continues on over time, some patients can develop advanced lung disease from COVID.
– And so what sort of conversations should patients be having with their PCP about their lung health?
– Well, a patient should be very candid and open with their PCP. They should really tell them what symptoms they’re exactly having. It’s very hard as a physician to really know or have a heightened level of concern if you really don’t know how an individual is doing at home, how they’re functioning, how short of breath they are, the activities they can do. Are they having a hard time, you know, just doing some of the, what we call activities of daily living like bathing, showering, getting dressed? So individuals should really be open and say, “You know, doctor, I have a hard time doing this,” or, “My cough is really severe. I have a lot of mucus production in my lungs that really prohibits me from sleeping at night, from getting outside, from going to the store.” So patients really need to get that relationship of trust with their physician and really communicate exactly how they are doing to their physician.
– And when you see success stories, what is that like for you?
– It’s great. I love my job. You know, it’s wonderful to see individuals who really struggle, who really have a hard time due to the lung disease. And they come to UPMC and get this evaluation for transplant. And then when they get their transplant and get listed and end up going home, and see them have a wonderful quality of life and see them, you know, get back to full-time work. Some of the younger patients that get married, have children, go back to school, and have great jobs and live that life that they’ve always dreamed of. It’s very satisfying to me as a physician to work with these patients and really help them get their their health in tip-top shape, which allows them to do that.
– Well, doctor, some great information. We thank you so much for your time today. Thank you for joining us.
– Thank you for this opportunity.
– And I’m Tania Caruso. Thank you for joining us. This is UPMC HealthBeat.
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About Transplant Services
Established in 1981, UPMC Transplant Services is one of the foremost organ transplant centers in the world. Our clinicians have performed more than 20,000 organ transplant procedures, including liver, kidney, pancreas, single and double lung, heart, and more. We are home to some of the world’s foremost transplant experts and have a long history of developing new antirejection therapies—so organ recipients can enjoy better health with fewer restrictions.