Dedicated to the Care of Patients with Pulmonary Disease

The Lung Transplant Program at University Hospital was established in 1987 by a pioneer in Lung Transplantation, Dr. John Kent Trinkle. University Health System in partnership with The University of Texas Health Science Center at San Antonio has been leaders in the care of people with end stage lung disease. Every patient referred to the Lung Transplant program benefits from our strong history of research, education, creative innovation, comprehensive medical expertise and surgical excellence.

Pioneering Force in Lung Transplantation

• In 1987 we performed the first lung transplant in North America for the treatment of emphysema.
• In 1987 we performed the first heart/double lung transplant in San Antonio.
• In 1989 we performed one of the first single lung transplants in the World for pulmonary hypertension.
• Dr. J. Kent Trinkle developed a surgical method in lung transplant called "telescoping". This was developed to decrease the problems of rupture and narrowing of bronchial suture sites.

Benefits from Creative Innovation

Patients at University Transplant Center and across the nation will benefit from the creativity of our physicians as seen in the San Antonio Lung Transplant (SALT) Protocol and the development of the Single Lung Transplant (SLT) Calculator.

• SALT Protocol: The primary limiting factor to lung transplantation is the lack of available organs. Dr. Luis Angel, Medical Director of the Lung Transplant Program led his team to develop a protocol for lung-donor management to increase the number of lungs for transplantation with out affecting the survival rates of recipients. The outcome of this protocol was associated with a significant increase in the number of lung donors and transplant procedures without compromising pulmonary function, length of stay, or survival of the recipient. Patients across the nation have benefited from this research. Link to article http://ajrccm.atsjournals.org/cgi/reprint/174/6/710
• Single Lung Transplant Calculator: The decision to do a single vs. a double lung transplant in patients with emphysema and pulmonary fibrosis is controversial. This determination is frequently based on the patients’ disease, age, and medical history. Dr. Angel developed a calculation using certain values from the results of a patient’s Pulmonary Function Test (PFT) and their gender to predict the best FEV1 value and FEV1 percentage of predicted a patient will have post transplant with a single lung transplant. This was found to be strongly associated with post lung transplant survival. Link to calculator: http://deb.uthscsa.edu/SLTCalc/Pages/sltcalc.jsp

Volume

Our program has transplanted over 300 patients from its inception. We have accepted some very challenging surgical cases, including patients that have been turned down at other centers across the country. We do select the most appropriate candidate for the surgery.

Outcomes

We have transplanted some of the longest surviving lung transplant patients in the nation. Despite taking on some of the most challenging cases our survival statistics meet the national average. 

Transplant Candidate Selection

• Patients with advanced lung disease
• Failed all possible medical therapies available to them
• High risk of death in one to two years
• Poor quality of life secondary to lung disease

Our Suggested Age Limits Are:

Single Lung Transplant < 70 years old
Double Lung Transplant < 65 years old

Diagnoses

A lung transplant may be needed for the following diseases:

Interstitial Lung Diseases
Idiopathic Pulmonary Fibrosis (IPF)
Sarcoidosis
Hypersensitivity Pneumonitis
Pulmonary Manifestations of Collagen Vascular Disease
Eosinophilic Granuloma
Lymphangiomyomatosis (LAM)

Pulmonary Vascular Disorders
Primary Pulmonary Hypertension (PPH)

Obstructive Lung Diseases
Chronic Obstructive Pulmonary Disease (COPD)/Emphysema
Alpha 1 Antitrypsin Deficiency

Bronchiectasis
Cystic Fibrosis

Other rare conditions may be considered for lung transplantation

TRANSPLANTS PERFORMED AT UNIVERSITY TRANSPLANT CENTER

Reasons not to transplant

• Active Cancer
• Hepatitis B
• Hepatitis C with cirrhosis proven by liver biopsy
• Current Substance Abuse: tobacco, alcohol, and illicit drugs. Patient must have proof of abstinence for 6 months before transplant evaluation.
• Absence of consistent or reliable social support
• Non compliance with prescribed medications/medical regimen
• HIV infection
• Dysfunction of other major organ systems
• Unresolved psychosocial issues or uncontrolled psychiatric illness
• Body Mass Index (BMI) >30 or <17. BMI is calculated using height and weight.

Calculate your BMI: http://www.nhlbisupport.com/bmi/

Mentor Program

The decision to go forward with the transplant evaluation and eventually be placed on the lung transplant list is a difficult one. The physician will provide you with a large amount of information regarding the transplant process but the ultimate decision is yours. After you have been seen in our clinic we can provide you with a mentor. This is someone with your same lung disease who has been through the evaluation process and transplanted at our facility. 

Referral Process

A referral may be sent via the computer simply by clicking on the link below. Please fill out the referral page and a transplant coordinator will contact you. If you would prefer to talk to someone directly and have questions you can call toll free at 1-888-336-9633 or 210-567-5777.

Fill out the referral form.

Evaluation Process

Patients must be evaluated to determine their candidacy for transplantation. An initial visit will be scheduled with our transplant pulmonologist and coordinator. During this visit the transplant pulmonologist will review the medical records, films, visit with patient and do a physical exam. This visit will determine if the patient should proceed with the transplant evaluation. If performed at our facility the evaluation will take up to 4 days on an outpatient basis. The evaluation is a battery of tests.

View the detailed evaluation process in the Patient Handbook.

Transplant Committee

After you have finished your full evaluation the transplant committee will determine your suitability for transplant. The committee is made up of: Transplant Pulmonologists, Transplant Surgeons, Nurse Coordinators, Social Workers, Dietitian, and Financial Counselors. Based on the results of the exams the committee will make the decision to place the patient on the transplant list or request further testing or may decide that the patient is not a candidate for transplant. 

Transplant List/Lung Allocation Score

Once you are placed on the lung transplant list, you will be matched with a donor based on your blood type/body size. Your priority for transplant will depend on your Lung Allocation Score (LAS). The LAS determines a patient’s medical urgency for transplant and probability of success post transplant. A LAS will be assigned to a patient on a scale of 0-100 using the following parameters:

• Date of Birth
• Lung Diagnosis
• Functional Status
• Assisted Ventilation
• Height and Weight
• Diabetes
• Supplemental Oxygen
• Percent Predicted FVC
• Six Minute Walk Distance
• Serum Creatinine
• Pulmonary Artery Systolic Pressure
• Mean Pulmonary Artery Systolic Pressure
• PCO2
• Pulmonary Capillary Wedge Mean

Link to LAS Calculator: www.UNOS.org/resources/frm_LAS_Calculator.asp?index=98

The length of time a patient waits on the transplant list varies from patient to patient.

From 2005 to September 2008 the median wait time a patient spends on the transplant list at University Transplant Center is 32 days. 

Transplant Surgery

Most Transplant Patients...

• Are in surgery approximately 3-8 hours
• Spend 1 day on the breathing machine
• Spend 1-3 days in the intensive care unit
• Are discharged 12 days after their surgery 

Hospital Stay

The J. Kent Trinkle Transplant unit creates an atmosphere dedicated to the compassionate care of the patient and family:

• State of the art facilities
• Cutting edge technology
• All private rooms
• Physicians in hospital 24 hours a day

Follow up Care

After transplant, patients are followed closely in our clinic. The first 3 months we require weekly visits to our clinic. During this period blood levels are drawn to adjust medications as necessary; chest x-rays and pulmonary functions tests are performed to assess the condition of the lungs. After the first 3 months the appointments will be scheduled further apart depending on the progress of the patient. We strongly encourage the referring doctor to contact us with any questions or problems.

View the Patient Education Handbook

Other Areas of Expertise

• Pulmonary Hypertension
• Lung Cancer
• Tracheal Stenosis
• Complicated Pleural Effusions
• Tracheomalasia

 Interventional Pulmonology

• Rigid Bronchoscopy
• Stent Placement
• Laser, Cryotherapy, Electrocoagulation
• Percutaneous Tracheostomy

For referrals (Non-Transplant) to the Other Areas of Expertise or Interventional Pulmonology please call 210-358-8001.