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Experts at Cedars-Sinai Medical Center Expect Lung Transplant Survival Rates to Continue to Trend Upward

New anti-rejection regimes that are strong yet targeted are lowering infection rates and increasing survival rates of lung transplant patients like 61-year-old Dennis Scott, who was back at work three months after his life-saving surgery at Cedars-Sinai Medical Center.  Experts there expect the survival rates to trend upwards due to improvements in post-surgical management.  

Experts at Cedars-Sinai Medical Center Expect Lung Transplant Survival Rates to Continue to Trend Upward

Los Angeles - March 10, 2006 - Veteran police officer and SWAT team member Dennis Scott brushes off questions about frightening situations he encountered in his 22 years on the force. “You don’t even think about the danger.  You’re trained to do the job and you just do it.” But ask him about his battle with life- threatening lung disease and his tone changes.   

For more than a decade after he retired from the Santa Anna police department, Scott of Mission Viejo, Ca, suffered from the debilitating effects of emphysema, a condition that causes progressive damage to the air sacs inside the lungs.  .

“Every day became more and more of an effort.  I was sitting around knowing I was dying and I had to ask myself, “Who’s going to take care of my boys?”  

Scott suffered from a hereditary form of emphysema called alpha-1-antitrypsin deficiency, which may have been aggravated by years of exposure to smoke and firearm residue both in the field and as a firearms trainer.    

In May, 2005 Scott was seen for the first time by members of Cedars-Sinai Medical Center’s transplant team and his name was added to the nationwide list of patients waiting for a transplant.  Luckily, a donor lung became available within three months.  And exactly three months after his surgery, Scott was back working at his second career as a shopping mall security executive.

Scott’s attitude is upbeat.  “Every day’s a new day,” says the husband and father of five- and seven-year-old sons. “I’m not running any races yet, but I’m getting stronger all the time.  There aren’t enough words to describe the change in my quality of life.”

Not only was 61-year-old Scott fortunate to receive a donor lung quickly (the average waiting time is 300 days), but his chances for long-term survival are promising as the rates at Cedars-Sinai’s lung transplant program and other programs nationally continue to trend upward.   

According to George E. Chaux, M.D., medical director of Cedars-Sinai’s lung transplant program, Cedars-Sinai’s current one-year rate “is in the neighborhood of 85 percent (compared to a national rate of around 80 percent).  Our three-year rate is now 65-70 percent, and our five-year rate is 50 percent. I wouldn’t be surprised if in the next cohort of patients (those that we’re now transplanting) we find a better than 65-70 percent survival rate at five years.”   

Cedars-Sinai is one of a few medical centers in Southern California with Medicare certification for lung transplants. Surgeons performed 16 lung transplants there in 2005 but expect to more than double that number in 2006.

Chaux and Zab Mosenifar, M.D., medical director of the Cedars-Sinai Center for Chest Diseases attribute the improvements in survival rates to better post-surgical management including better immunosuppressants and antibiotics.  “We have a much broader range of agents at our disposal now than we did earlier.  The new anti- rejection regimes are very strong but at the same time they’re much more targeted so the infection rate is not as high,” says Mosenifar, who has been a leader in Cedars-Sinai’s lung transplant program for more than 25 years.   

Cyclosporine, which for many years was considered the cornerstone of immunosuppressant treatment, has been replaced by Prograf, a new medication.  Another new medication, Cellcept, when taken in combination with Prednisone, “while not perfect, seems to be better than the previous regime,” adds Chaux.

Transplanted lungs are considered foreign to the body, consequently they trigger the body’s immune system to attack and reject them.  Physicians prescribe immunosuppressive medications to prevent rejection, but because the immune system is impaired, the risk of infection increases.  

Chaux cites other recent changes in post-surgical management that are impacting survival rates.  “Physicians are also more aware of other conditions such as esophageal reflux disease.  Reflux disease is common among lung transplant patients and it contributes to lung dysfunction following transplantation. Some studies have shown a 70 to 80 percent incidence of esophageal reflux disease in this population. We’re now, therefore, treating all lung transplant patients for reflux disease whether or not they’re symptomatic.”    

Single lung transplants are the most common form of lung transplant surgery but double lung transplants and lung-heart transplants also are performed.  According to the American Lung Association, approximately 3,500 people in the United States were waiting for a lung transplant in 2005, but only 1,000 received a transplant. In addition to emphysema, other chronic lung conditions treated with transplants are pulmonary fibrosis, cystic fibrosis and pulmonary hypertension.  

Despite a nationwide effort to raise public awareness of the need for donated organs, there’s still a huge disparity between the number of organs available and the number of patients who need a transplant, Chaux emphasizes.  “While the allocation system has changed, we continue to have a fairly high mortality rate among patients waiting for a transplant.  We still have to wait for the generosity of families who make a decision to donate their loved one’s organs at a very difficult time.”

Scott appreciates the generosity that made his transplant possible.  When he and his wife were waiting at the hospital for his new lung to arrive, they were elated but they knew that somewhere, the donor’s family was sad.  “I don’t know if I’ll ever be able to grasp the magnitude of it,” he says. “It’s still mind-boggling how much my life changed in just 24 hours.