Dec. 17, 2022
Mayo Clinic Lung Transplant Program has been providing transplantation to patients with advanced lung disease since 1990. Under the joint leadership of medical director Cassie C. Kennedy, M.D., a pulmonologist at Mayo Clinic in Rochester, Minnesota, and surgical director Mauricio A. Villavicencio Theoduloz, M.D., a cardiovascular surgeon at Mayo Clinic in Rochester, Minnesota, the program focuses on improving referral to waitlist decision efficiency, promoting growth, and maintaining robust survival and patient satisfaction outcomes.
Referral to decision efficiency
Lung transplant referrals come from the patients themselves, Mayo physicians, both outpatient and inpatient, and non-Mayo physicians, including international referrals. In 2022, the average time from initial referral to selection conference decision decreased by 17% to get patients listed more quickly. All referrals are pre-screened by the medical director. If no absolute contraindications to transplantation are found, the patient is scheduled for a 5-to-7-day outpatient evaluation. A multidisciplinary selection conference occurs the following Monday. If patients have issues that prevent immediate listing, such as obesity or frailty, pre-transplant interventions can help patients achieve candidacy. If patients are determined to be too early in their disease process to consider transplant listing, referring pulmonologists follow best practices in advanced lung disease management on a quarterly basis until the timing of transplant is appropriate.
Increasing transplant volumes
In 2022, more than 50 lung transplants were performed at Mayo Clinic Rochester, which is a record number of lung transplant surgeries for the program. Once candidates are listed, they are typically seen every one to three months until transplanted. An on-call team of transplant nurse coordinators, transplant surgeons and transplant pulmonologists are available to advise and care for patients to help them avoid deterioration and prevent any transplant delays.
Nationally, the average time from waitlist to lung transplant is 6 weeks. Protocols are in place for patients with a significant amount of HLA antibodies against potential donor lungs, multiorgan transplantation, or heart-lung, bridge to transplant with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) for ill patients, and cardiac revascularization to allow more patients a transplant opportunity. In some cases, patients have the option of accepting transplant offers from an expanded donor pool. For example, a preemptive therapy protocol allows consenting patients to receive donor lungs that are positive for hepatitis C without concern for acquiring chronic hepatitis C.
Maintain optimal outcomes
In the national Scientific Registry of Transplant Recipients (SRTR) reporting period between Jan. 1, 2019, and June 30, 2021, one-year survival was 100% with an expected survival listed as 90.8% and the national expected survival of 89.5%. Mayo Clinic's Lung Transplant Program maintains high patient satisfaction with Press Ganey survey reports showing that more than 90% of the lung transplant candidates and recipients would recommend care at Mayo Clinic in Rochester, Minnesota.
Furthermore, patient satisfaction is enhanced by access to the Gift of Life Transplant House, a low-cost housing option for transplant patients and their caregiver where on-site exercise and venipuncture/ laboratory draws are offered. Additionally, transplant social workers provide weekly transplant patient and caregiver support groups. Daily pulmonary rehabilitation post-transplant ensures that patients become active as quickly as possible.
Other lung transplant updates at Mayo Clinic include:
- National Institutes of Health-sponsored behavioral intervention clinical trials.
- Recent completion of a gold-status quality improvement project to increase hospital dismissal efficiency.
- The initiation of an inaugural year of a new Advanced Lung Disease and Lung Transplant Fellowship from July 1, 2023, to June 30, 2024.
For more information
A study to evaluate wellness coaching for caregivers of thoracic transplant candidates. Mayo Clinic.
Pre-transplant health coaching to improve patient-reported outcomes in lung transplant candidates. Mayo Clinic.
Refer a patient to Mayo Clinic.