Lung Transplant Program

Cleveland Clinic's Lung Transplant Program is a leader in lung transplants, both for patient volumes and successful outcomes. Since the program's inception in 1990, we have performed over 1,100 transplants with long term survival rates above the national average.

Another unique feature of our transplant program is that patients can live within 1,000 miles of the Cleveland area while awaiting an organ, which means they do not have to relocate to Cleveland. We follow our patients for the life of their transplant for continuity of care, and we collaborate with their local physicians. Our transplant physicians are committed to helping transplanted patients receive as much care as possible close to their homes. The goal is to return each transplant patient to his or her primary care physician or referring physician within three to six months after transplant.

A Team Approach

Cleveland Clinic's Lung Transplant Team is specially trained in meeting the needs of lung transplant patients. The team is committed to providing comprehensive care in a compassionate setting. The Lung Transplant Team members include:

• Transplant surgeons
• Transplant pulmonologists
• Infectious disease team
• Pharmacologists
• Transplant coordinators
• Transplant fellows and residents
• Registered nurses
• Nursing assistants
• Dietitians
• Social Workers
• Financial counselors
• Physical therapists

For More Information

Jacquline Freshwater
Department Coordinator
Phone: 216.444.8282 or 800.223.2273 x48282

Cleveland Clinic specializes in “high risk” transplant candidates, including patients with:

• Chronic obstructive pulmonary disease (COPD)/emphysema
• Fibrotic lung disease
• Cystic fibrosis/bronchiectasis

Other medical conditions treated with lung transplant surgery include:

• Primary pulmonary hypertension
• Idiopathic pulmonary fibrosis
• Interstitial pneumonitis
• Alpha 1 antitrypsin deficiency
• Sarcoidosis
• Graft failure requiring re-transplant

More Information

Learn more about the Lung Transplant process.

• Overview of Lung Transplantation
• Pre-Transplant Evaluation
• Your Commitment to Good Health
• Financial Questions
• Transplant Glossary
• Lung Transplant Resources

Lung Transplant FAQ

»What are the benefits of lung transplantation?

Following lung transplantation, both lung function and the ability to exercise (better termed the exercise capacity) are dramatically improved. Often, these results are seen immediately following the actual transplant operation. In addition, many times supplemental oxygen is no longer needed once patients are discharged from the hospital.

According to the data from the International Society of Heart and Lung Transplantation, 56% of lung transplant recipients have no activity limitations one year after transplantation. Overall, the ability to exercise is improved, allowing the majority of patients to resume very active lifestyles, allowing patients a greater sense of freedom. Patients are no longer burdened by the use of supplemental oxygen, and activities such as travel and exercise are often possible.

»What are the risks of lung transplant?

The risks of lung transplantation are the same of those associated with any surgery. There is the risk of infection, bleeding, and breathing problems that might not improve after surgery. There is always the risk of, and most patients experience some side effects from medicines to suppress the immune system. Many of these side effects can be controlled by lowering doses of medicines or adding medicines to control the side effects.

If the body recognizes the new lung(s) as a foreign object, it will normally try to get rid of or reject it. You will be given medicines called immunosuppressants to prevent or reverse this process. You will take these medicines for the rest of your life. These medicines, given to prevent rejection, lower your body’s ability to fight infection. Therefore, you might be more prone to infections, as well as some types of lymphomas and other cancers during the post-transplant period.

»Where do donor lung(s) come from?

Organ donations are called “the gift of life.” The donors are hospital patients who have died and who have notified their next of kin or had indicated that they want to be organ donors. In the United States, death is defined clearly as the cessation of cardiopulmonary function or irreversible cessation of all brain functions, including those of the brain stem. Usually, brain death is the result of severe brain injury, such as a gunshot wound, major car accident, stroke, or other significant injury to the brain.

The most common circumstances surrounding brain death are not car accidents, as commonly thought, but actually strokes or ruptured blood vessels in the brain, called aneurysms. When someone dies or is near death, the hospital contacts the local organ procurement organization (OPO). OPOs are not-for-profit organizations that coordinate activities related to obtaining organs. Organ donors are carefully evaluated to ensure they can be safely transplanted and no known treatable diseases are transmitted to the recipient.

Once donor lungs are deemed suitable, a pre-transplant coordinator at the transplant center contacts the transplant surgeons caring for the top-ranked patient to offer the organ(s). The top-ranked patient is the patient highest on the waiting list, ranked according to objective criteria, including blood type, size of the donor organ, and time spent on the waiting list, as well as distance from the transplant center.

The waiting list has been determined by your transplant center and indicates you are a good candidate for transplantation. You are then placed on a national waiting list with the United National Organ Sharing (UNOS) in hopes of finding a suitable donor for you. Waiting for a suitable or appropriate organ for a lung or set of lungs might take anywhere from several days to many months, and in some cases years. This can be a difficult period for patients and family members, and we often recommend and provide information about local support groups.

»Why do I need an evaluation?

An evaluation is done to help identify any potential problems that might occur after transplantation, and to eliminate or avoid those problems. Routine blood tests are done to see if you have been exposed to certain viruses. These blood tests tell us how your other organs and systems – such as the liver and immune system—are working.

During your initial visit, you and your family members will meet with a transplant doctor to learn more about the procedure, including the pros and cons of transplantation. This team visit is designed to not only help answer many of your questions but to allow the transplant team to learn more about you. In addition to reviewing your medical history and performing blood tests, we will obtain a chest x-ray, a pulmonary function test, and an arterial blood gas test. A six-minute walk test is also required.

The following tests might also be performed.

• A Chest CT scan is a computerized x-ray of the chest that gives a more detailed picture of the lungs and the lining of the chest wall, called the pleura. This test is used to rule out ant evidence of cancer and to determine the extent of lung disease. In addition, it is sometimes used to determine which lung has sustained the most damage or has been most affected by the disease process.
• An electrocardiogram (EKG) records your heart rhythm and shows how fast your heart is beating. Other cardiac tests that might be performed include echocardiography, or echo, which is an ultrasound of the heart. This test allows your doctor to better assess the muscles and valves, and the presence of any abnormal function.
• A left heart catheterization is usually performed in patients 40 years and older or in those who have a history of heart problems. This is an invasive procedure performed in a cath lab and involves inserting a catheter into the artery in the groin and advancing it into the heart. Dye is injected through the catheter to take pictures of the heart and coronary arteries. In addition, this test allows for measuring various pressures in the heart chambers. This test usually takes about an hour and a half, and medicines are usually given to help you relax.
• A right heart catheterization is similar to a left heart catheterization but is used to measure the specific pressures in your lungs and the right side of your heart. Many times, the catheter is inserted into a large vein—either in the groin or in the neck—and advanced to the heart where the pressures of the chambers of the heart are measured and recorded. This procedure is also done in a cath lab, but takes less time. It can take about 15 minutes to half an hour. Once again, you will be given medicines to help you relax. For both procedures, patients will need to lie flat for two to four hours afterward to prevent bleeding at the site where the catheter was inserted.
• A VQ scan is another test to assess how much air movement and blood flow goes to each lung. This is used to rule out any blood clots in the lungs, called pulmonary embolisms. It also gives the surgeon information used to decide which lung to transplant in the case of a single lung transplant or which lung to transplant first in a bilateral (both sides) lung transplant.
• A six-minute walk test consists of walking six minutes with oxygen, if needed, at your own pace with no incline. This test is to see what happens to your oxygen saturation with exercise and to measure your endurance by the distance you can cover in about six minutes.
• Other tests that will be performed include skin testing to check both exposure to tuberculosis and a 24-hour urine collection to test your kidney function. Women must have a gynecology consult and Pap smear during the work-up to rule out any cancers of the reproductive system. Men must have a prostate exam with a prostate specific antigen (PSA) test to rule out cancer. All patients should have a routine dental exam to identify any potential sources of infection in the mouth.

»Who can I discuss the transplant process with?

A clinical social worker who is an expert in the area of transplantation will meet with you and your family members to review any psychosocial issues or concerns, to discuss the transplant process, and to answer any questions you might have.

Healthy reminders for those awaiting a transplant

»When was your last pneumonia shot?

Pneumonia shots are needed every five to seven years.

»Are you taking steroids for more than six months?

Remind your doctor to order your bone density test.

»Are you getting enough sleep?

Research has shown that proper amounts of sleep and exercise along with a nutritiously balanced diet result in a body that is in top form, physically, mentally and spiritually.

Web Resources

• Office of Minority Health (OMH)
• Healthy People

The following Cleveland Clinic Transplant Center doctors and staff specialize in Lung Transplant:

Clinical Trials

Decision-making for Emphysema Patients Considering Lung Transplantation (DECIDE)

This study examines the choices made by patients with COPD (Emphysema) to undergo lung transplantation. This is a multi-center observational survey study for patients diagnosed with COPD (Emphysema). For questions, please contact Chenett Greer at 216.445.9287.

Immune Mechanisms of Rejection in Human Lung Allografts (HLA II)

The purpose of this study is to find the lung transplant recipients who develop antibodies to the transplanted lung and to determine whether it is beneficial to start treatment in order to delay or prevent chronic rejection before the development of symptoms. This a National Institutes of Health-National Heart, Lung, and Blood Institute sponsored, multi-center, sample collection study for patients undergoing lung transplantation. For questions, please contact Chenett Greer at 216.445.9287.

BAR Study

Info. will be coming from the study coordinator in the CVI.

Prevalence of Erectile Dysfunction in Lung Transplant Recipients (ERD)

The purpose of this study is to examine the cause of erectile dysfunction in male lung transplant patients 18 years and older. This is a single center observational survey study for all men undergoing lung transplantation. For questions, please contact Chenett Greer at 216.445.9287.

Recommended Research Readings

Below is a list of recent peer-reviewed research articles about Lung Transplant written by Cleveland Clinic doctors and staff.

• Impact of pulmonary hemodynamics on 6-min walk test in idiopathic pulmonary fibrosis.
  Minai OA, Santacruz JF, Alster JM, Budev MM, McCarthy K. Respir Med. 2012 Nov;106(11):1613-21. doi: 10.1016/j.rmed.2012.07.013. Epub 2012 Aug 16.
• Growing single-center experience with lung transplantation using donation after cardiac death.
  Mason DP, Brown CR, Murthy SC, Vakil N, Lyon C, Budev MM, Pettersson GB. Ann Thorac Surg. 2012 Aug;94(2):406-11; discussion 411-2. doi: 10.1016/j.athoracsur.2012.03.059. Epub 2012 May 18.
• Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation.
  Murthy SC, Nowicki ER, Mason DP,Budev MM, Nunez AI, Thuita L, Chapman JT, McCurry KR, Pettersson GB, Blackstone EH. J Thorac Cardiovasc Surg. 2011 Jul;142(1):47-52.e3. doi: 10.1016/j.jtcvs.2011.04.028.
• Lung transplantation in a recipient with novel 2009 H1N1 influenza: lessons learned.
  Mason DP, Murthy SC, Yun JJ, Machuzak M, Shrestha R, Avery RK, McCurry KR, Budev MM, Pettersson GB. Thorac Cardiovasc Surg. 2011 Mar;59(2):126-7. doi: 10.1055/s-0030-1250240. Epub 2011 Mar 7.
• Third-time lung transplantation in a patient with cystic fibrosis.
  Vakil N, Mason DP, Yun JJ, Murthy SC, Budev MM, Pettersson GB. J Thorac Cardiovasc Surg. 2011 Jan;141(1):e3-5. doi: 10.1016/j.jtcvs.2010.09.028. Epub 2010 Nov 18. No abstract available.
• Clinical course after successful double lung transplantation in a patient with severe scoliosis.
  Garcha PS, Santacruz JF, Machuzak MS, Budev MM, Mehta A. J Heart Lung Transplant. 2011 Feb;30(2):234-5. doi: 10.1016/j.healun.2010.09.003. Epub 2010 Oct 23. No abstract available.
• Ulcerative leg nodules in a transplant recipient.
  Chua AP, Billings SD, Budev MM, Mehta AC. Cleve Clin J Med. 2009 Oct;76(10):575-6, 616. doi: 10.3949/ccjm.76a.09006. No abstract available.
• Temporal pattern of transfusion and its relation to rejection after lung transplantation.
  Mason DP, Little SG, Nowicki ER, Batizy LH, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. J Heart Lung Transplant. 2009 Jun;28(6):558-63. doi: 10.1016/j.healun.2009.03.001. Epub 2009 May 5.
• Matching donor to recipient in lung transplantation: How much does size matter?
  Mason DP, Batizy LH, Wu J, Nowicki ER, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. J Thorac Cardiovasc Surg. 2009 May;137(5):1234-40.e1. doi: 10.1016/j.jtcvs.2008.10.024.
• Bronchogenic carcinoma after lung transplantation: characteristics and outcomes.
  Minai OA, Shah S, Mazzone P, Budev MM, Sahoo D, Murthy S, Mason D, Pettersson G, Mehta AC. J Thorac Oncol. 2008 Dec;3(12):1404-9. doi: 10.1097/JTO.0b013e31818e1259.
• Successful double lung transplantation in 2 patients with severe scoliosis.
  Su JW, Mason DP, Murthy SC, Budev MM, Mehta AC, Goodwin R, Pettersson GB. J Heart Lung Transplant. 2008 Nov;27(11):1262-4. doi: 10.1016/j.healun.2008.07.014.
• Should lung transplantation be performed using donation after cardiac death? The United States experience.
  Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. J Thorac Cardiovasc Surg. 2008 Oct;136(4):1061-6. doi: 10.1016/j.jtcvs.2008.04.023.
• Does noninvasive positive pressure ventilation have a role in managing hypercapnic respiratory failure due to an acute exacerbation of COPD?
  Gershman AJ, Reddy AJ, Budev MM, Mazzone PJ. Cleve Clin J Med. 2008 Jun;75(6):458-61. No abstract available.
• Accuracy of the physical examination in evaluating pleural effusion.
  Diaz-Guzman E, Budev MM. Cleve Clin J Med. 2008 Apr;75(4):297-303. Review.
• Early experience with lung transplantation using donors after cardiac death.
  Mason DP, Murthy SC, Gonzalez-Stawinski GV, Budev MM, Mehta AC, McNeill AM, Pettersson GB. J Heart Lung Transplant. 2008 May;27(5):561-3. doi: 10.1016/j.healun.2008.01.023.
• Spirometry after transplantation: how much better are two lungs than one?
  Mason DP, Rajeswaran J, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Ann Thorac Surg. 2008 Apr;85(4):1193-201, 1201.e1-2. doi: 10.1016/j.athoracsur.2007.12.023.
• Decortication after lung transplantation.
  Boffa DJ, Mason DP, Su JW, Murthy SC, Feng J, McNeill AM, Budev MM, Mehta AC, Pettersson GB. Ann Thorac Surg. 2008 Mar;85(3):1039-43. doi: 10.1016/j.athoracsur.2007.10.096.
• Atrial fibrillation after lung transplantation: timing, risk factors, and treatment.
  Mason DP, Marsh DH, Alster JM, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Ann Thorac Surg. 2007 Dec;84(6):1878-84.
• Dialysis after lung transplantation: prevalence, risk factors and outcome.
  Mason DP, Solovera-Rozas M, Feng J, Rajeswaran J, Thuita L, Murthy SC, Budev MM, Mehta AC, Haug M 3rd, McNeill AM, Pettersson GB, Blackstone EH. J Heart Lung Transplant. 2007 Nov;26(11):1155-62.
• Treating pulmonary arterial hypertension: cautious hope in a deadly disease.
  Minai OA, Budev MM. Cleve Clin J Med. 2007 Nov;74(11):789-93, 797-800, 802 passim. Review.
• Diagnostic strategies for suspected pulmonary arterial hypertension: a primer for the internist.
  Minai OA, Budev MM. Cleve Clin J Med. 2007 Oct;74(10):737-47. Review.
• Lung transplantation for idiopathic pulmonary fibrosis.
  Mason DP, Brizzio ME, Alster JM, McNeill AM, Murthy SC, Budev MM, Mehta AC, Minai OA, Pettersson GB, Blackstone EH. Ann Thorac Surg. 2007 Oct;84(4):1121-8.
• Plasma receptor for advanced glycation end-products predicts duration of ICU stay and mechanical ventilation in patients after lung transplantation.
  Calfee CS, Budev MM, Matthay MA, Church G, Brady S, Uchida T, Ishizaka A, Lara A, Ranes JL, deCamp MM, Arroliga AC. J Heart Lung Transplant. 2007 Jul;26(7):675-80.
• Restless legs syndrome in lung transplant recipients.
  Minai OA, Golish JA, Yataco JC, Budev MM, Blazey H, Giannini C. J Heart Lung Transplant. 2007 Jan;26(1):24-9.
• Acanthosis nigricans following single lung transplantation: a case report.
  Pandya C, Blazey H, Budev MM, Mehta AC, Minai OA. Prog Transplant. 2006 Sep;16(3):239-41. Review.
• Extended use of extracorporeal membrane oxygenation after lung transplantation.
  Mason DP, Boffa DJ, Murthy SC, Gildea TR, Budev MM, Mehta AC, McNeill AM, Smedira NG, Feng J, Rice TW, Blackstone EH, Pettersson BG. J Thorac Cardiovasc Surg. 2006 Oct;132(4):954-60.
• Referral for lung transplantation: a moving target.
  Minai OA, Budev MM. Chest. 2005 Mar;127(3):705-7. No abstract available.

Patient Referrals

Our secure online service, Dr.Connect, provides referring physicians access to patient’s treatment progress with streamlined communication from Cleveland Clinic physicians to your office, allowing continued participation in the ongoing care of patients. With the best possible treatment plans and coordinated care, our team approach benefits both the patient and the referring physician.

• Learn more about physician referrals to Cleveland Clinic's Respiratory Institute.

Pulmonary and Critical Care Medicine Fellowships

Our pulmonary and critical care medicine fellowships provide board-certified general internists with the tools necessary to care for patients, who have complicated lung diseases and critical illnesses. During the three-year training period, which includes an 18-month core program and 18-month subspecialty track, fellows are exposed to a wide variety of medical problems in both the inpatient and outpatient settings.

• Learn more about our pulmonary and critical care medicine fellowships.

CMEs

Cleveland Clinic Respiratory Institute offers continuing medical education courses through the Center for Continuing Education. We are providers of AMA-approved continuing medical education (CME) units for physicians and physician assistants, and of continuing education units by the Ohio Nurses Association for nurses and by the Ohio Respiratory Care Board for respiratory therapists.

• View all pulmonology-related CME offerings.