Program Spotlight: Lung Transplantation

July 15, 2017

UH Transplant Institute

July 2017


Director of Lung Transplantation, UH Transplant Institute; Associate Professor, Case Western Reserve University School of Medicine

"If you can't breathe, nothing else matters," says Robert Schilz, D.O., director of lung transplantation at University Hospitals Transplant Institute, in Cleveland, Ohio.

For people with advanced lung disease, medication therapy often fails in later stages of the illness. At this stage, lung transplantation may be a patient's only option for treatment. And many patients face a significantly shorter future if they do not receive a transplant in a timely manner.

Dr. Schilz and the lung transplantation team at UH Transplant Institute spend their days and nights helping people get a second chance at life.

"Lung transplantation gives hope to patients who otherwise have no other option," he says. "It represents more time for their families, professions and enjoyment of everyday life. It allows them to not just exist, but to be active and do all the things they love to do.”

He adds, “Seeing the smiles on patients’ faces when they can breathe and walk again is priceless and immensely rewarding. Our patients have so much gratitude for their newly found life and future."

What makes the UH lung transplant program unique?

There are only approximately 60 lung transplant centers in the United States.

"To have our program right here in Cleveland is a tremendous advantage for referring physicians and their patients," says Dr. Schilz.

The lung transplant program at UH Transplant Institute offers many advantages, including:

  • Carefully coordinated patient care across all specialties.
  • Decades of research and experience.
  • Higher than expected survival rate.
  • Highly qualified multidisciplinary team of transplant experts.
  • Ongoing communication with established health care providers.
  • Partnership with official Cystic Fibrosis Center at Rainbow’s Children’s and Babies.
  • Shorter wait time on the transplant list.

"We take a collaborative approach to caring for end-stage lung disease patients," says Dr. Schilz. "Our patients are not on an assembly line; they are not just another number. We get to know everyone and consider patients part of our family."

During patient visits, the team:

  • Assesses the patient's vital signs and progress.
  • Consults directly with patients and families to ensure that the care plan is meeting their needs.
  • Discusses potential immunosuppression issues as well as discharge plans. 
  • Examines surgical incisions for healing or infection.
  • Measures graft function. 
  • Provides an update to the patient’s referring physician.

Team members stay involved throughout the patient’s life. Once at home, the patient follows a comprehensive outpatient treatment plan coordinated by the University Hospitals transplant coordinator. Such a plan helps ensure the patient’s continued compliance and optimum health. And, a transplant team staff member is always available to answer questions.

Transplant coordination

Our clinical transplant coordinator maintains close communication with all our lung transplant candidates, providing reassurance, answering questions and monitoring the patient's health status.

Once an appropriate organ is identified:

  • The transplant coordinator will call the patient and schedule the surgery.
  • Upon arrival to the hospital, the patient will undergo a physical examination, chest X-ray, electrocardiogram, and blood and tissue analysis to ensure he or she is compatible with the donated organ and is suitable for transplantation. 
  • The surgeon will thoroughly examine the donated organ to determine if it is a good match for the patient's age and medical status.

Once these steps have been completed successfully, transplantation can proceed.

What can referring physicians expect?

If you are a physician who treats patients with end-stage organ failure, the first step is forming a partnership with a transplant program.

"I follow many patients who are currently too well for a transplant, but are likely going to be candidates in the future," says Dr. Schilz.

When a patient is referred to UH, the team educates them, monitors their medication therapy and formulates a plan for the future, which may include transplantation.

"We rely on referring physicians for the management of patients," he says. "We are forming a partnership and can be a useful partner in the next phase of care, which is often transplantation. We help keep track of where the patient is and when the optimal timing may be for the transplant process."

The referring physician’s insights are critical to a patient’s successful recovery, so our team maintains close communication with the physician before, during and after transplant.

We communicate with referring physicians through:

  • Medical report sharing
  • Phone calls 
  • Written correspondence after inpatient and outpatient visits

Our goal is to keep you informed of your patient’s progress and condition. The transplant physician and referring physician may also collaborate to provide follow-up care and quality medical service throughout the patient’s life.

Who is a candidate for lung transplantation?

A patient with end-stage pulmonary disease may be a candidate for a lung transplant if he or she is:

  • Capable of participating in pre- and postoperative rehabilitation programs and follow-up care.
  • Free from major psychosocial problems.
  • Free from other major organ diseases.
  • Younger than 70 years of age.

Who is not a candidate for lung transplantation?

A patient with end-stage pulmonary disease is generally not considered a candidate for lung transplant if he or she is currently a smoker and/or has:

  • An active or system infection.
  • History of major cancer within five years.
  • Major psychiatric illness.
  • Significant systemic or multisystem disease.
  • Significant hepatic disease.
  • Significant renal disease.
  • Other major medical illness.

Patients must quit smoking at least six months prior to transplant and commit to not smoking post-transplant.

When to refer a patient for lung transplant

Lung transplantation may be considered as therapy for advanced irreversible lung diseases.

Advances in physician experience and organ availability continue to expand the range of patients who may be candidates for a lung transplant. Patients with the following lung diseases may be referred for transplant consideration:

  • Alpha-1 antitrypsin deficiency
  • Bronchiectasis
  • Bronchopulmonary dysplasia 
  • Certain hereditary conditions that affect the lungs 
  • Congenital abnormalities
  • Chronic obstructive pulmonary disease (COPD) (including emphysema)
  • Cystic fibrosis
  • Eisenmenger’s syndrome
  • Heart disease
  • Histiocytosis
  • Idiopathic pulmonary fibrosis
  • Lymphangioleiomyomatosis (LAM)
  • Obliterative bronchiolitis
  • Occupational lung disease
  • Primary pulmonary hypertension
  • Pulmonary fibrosis
  • Pulmonary hypertension
  • Sarcoidosis

Our multidisciplinary team evaluates potential lung transplant patients to determine whether transplantation or other therapies represent the optimal treatment approach.

When can patients expect to receive a lung transplant?

The time to organ transplant varies based on the patient's individual circumstance and the availability of donor lungs. See our Access and Wait Times article for more details on our above-average waitlist times.

Learn more about lung transplantation

To learn more about our programs, or to consult the UH Transplant Institute, please call our dedicated Intake Center at 216-844-3689.

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or 800-552-8338

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