St. Luke's Hospital discharges first heart/lung transplant recipient

Thursday, April 04, 2002

JACKSONVILLE, Fla., April 4, 2002 — The first patient to undergo a combined heart and lung transplant at Mayo Clinic/St. Luke's Hospital, is being discharged tomorrow. On Feb. 13 a team, led by Drs. Lawrence McBride and Octavio Pajaro, performed the 14-hour, multi-organ transplant on a 60-year-old Arkansas woman who suffered from primary pulmonary hypertension.

Primary pulmonary hypertension, a rare disorder in itself, is one of the few remaining indications for a heart and lung transplant. The disorder is characterized by unexplained, extremely high blood pressure in the pulmonary artery. The pulmonary artery carries blood from the right ventricle of the heart to the lungs where it picks up needed oxygen. The abnormally high blood pressure causes changes in the small blood vessels of the lungs that increase their resistance to the blood flow. This in turn causes the right ventricle to work harder to overcome the resistance in an effort to get blood to the lungs. Untreated, pulmonary hypertension is fatal.

Some patients can be treated with calcium channel-blocking drugs that relax the muscles of the heart and arteries, thereby improving the ability of the heart to pump blood. However, these drugs do not work for everyone. The next line of therapy is continuous infusion of a medication called prostacyclin.

"About 30 to 40 percent of patients will have a dramatic response to agents like prostacyclin," says Dr. Cesar Keller, the Mayo Clinic pulmonologist who cared for the patient. "About 30 percent will not have a dramatic response, but at least they remain stable and slowly improve over time. Then there is the 30 percent who no matter what you do, they keep getting worse, and obviously she belonged to that group." Transplantation is the only treatment option for these patients.

With the expectation that donor organs would be available sooner in Florida than in the Midwest, the patient was transferred from Mayo Clinic in Rochester, Minn., after failing medical treatments. "We had her listed for either a double lung or a heart/lung transplant," Keller says. "Our preference was always a heart/lung transplant because the degree of right heart dysfunction was extreme on her echocardiogram."

If untreated, or medically untreatable, pulmonary hypertension weakens the right ventricle of the heart, to the point where it can no longer pump blood to the lungs. And while patients might be cured with just a lung transplant, too much damage to the right ventricle necessitates a combined heart/lung transplant. "We were willing to do just the lungs if she were to continue to deteriorate too fast," Keller says. "Fortunately for her, we never had to make that decision because a donor heart and lungs became available."

Keller explains that even though donor organs are available more quickly in the Southeast compared to other regions of the country, there are still far too few available for the thousands of people on waiting lists. "You acknowledge that when you list patients for a heart and lung transplant it means they are competing for organs with heart recipients and lung recipients," he says. "So a lot of the indications for heart/lung transplantation at the beginning of the era of transplantation are no longer acceptable. In the beginning, heart/lung transplants were used for just about any chronic lung disease ¾ emphysema, cystic fibrosis, pulmonary hypertension ¾ because the technique was viable, and it was acceptable, and it was actually very functional."

Keller says that as the number of people waiting for organs outstripped the number of people willing to donate, it was inevitable that transplant science would have to advance in order to make maximum use of scarce organs. "We started learning that indeed, if you give most patients with chronic obstructive pulmonary disease, and most patients with pulmonary fibrosis, a good, single lung, they'll do functionally very well."

However, the upshot of advances that led to fewer patients requiring a heart/lung transplant also led to a decline in the number of surgeons trained and experienced in performing them. As a result, Keller says that in the United States only about 50 heart/lung combination transplants are done annually at only a few medical centers.

-30-

Media contact: Erik Kaldor 904-953-2299

###

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com is available as a resource for your health stories.