Stanford Hospital performs 500th lung transplant

Norbert von der Groeben

Patsy Nix underwent a double-lung transplant at Stanford Hospital last October.From the moment she took a breath in the Stanford Hospital & Clinics recovery room, 65-year-old Patsy Nix knew that her newly transplanted lungs were working. That first breath, she said, "was a miracle."

What she didn't know was that her transplant was far more than a personal landmark. Hers was the 500th lung transplant at Stanford, where a team lead by cardiothoracic surgeon Bruce Reitz, MD, completed the world's first successful heart- lung transplant in 1981.

Before Nix's transplant, every breath was an effort, hampered by lungs stiffened and scarred by idiopathic pulmonary fibrosis. "It was like an elephant sitting on my chest," Nix said. Even with the aid of oxygen, the simple act of walking from one room to another was impossible. When her local doctors told her that a transplant was the only option left to her, she was shocked. "Transplants happen to other people. I always thought they would be able to give me a pill that would make me better," she said.

By September, Nix was so sick that Stanford moved her quickly to the top of the waiting list. In October, the phone call came. "It was hard knowing that someone had to have passed away to give me the lungs," Nix said. As soon as she woke up after the six-hour surgery, she could feel the difference. "I had never smelled air that clean." Now back home in Lompoc, in Southern California, Nix is walking every day, rebuilding her physical strength.

Only a handful of the 80 lung transplant centers in the United States and Canada have performed as many lung transplants as Stanford, which has averaged about 50 annually, putting it in the top 10 percent of centers by volume. Its team also perform more heart-lung transplants than any other center in the nation each year.

"A milestone like this gives you the chance to look back on the efforts that have gone on here for a long time," said David Weill, MD, medical director of Stanford's lung and heart-lung transplant program since 2006. "I think about all the people we've helped and about the level of commitment shown by our team to get that done."

One of the innovations that Weill, professor of medicine, implemented after his arrival was creating the Center for Advanced Lung Disease, which specifically focuses on patients whose conditions are so serious that they can lead to transplants. "The approach is still unusual but is gradually being adopted at other transplant centers," Weill said. Treating patients earlier can help avoid transplant; it can also mean more successful transplants.

Stanford researchers are involved in clinical trials to test new ways to predict and avoid the most common and feared phenomenon, chronic rejection of the transplanted organ. As chair of the scientific council on pulmonary transplantation for the International Society for Heart & Lung Transplantation, Weill is working to create a standardized protocol for patient selection.

Reitz, who recently retired from active practice at Stanford, was chosen to perform the first heart-lung surgery by Norman Shumway, MD, PhD, the Stanford heart surgeon who completed the first successful adult heart transplant in the United States in 1968. Reitz had long been part of transplant research in Shumway's lab and was already an experienced physician, but the challenge of the lung was unique. Unlike other transplanted organs, it is directly exposed to outside air and bacteria after recovery through the normal act of breathing. Lungs remain the least often transplanted organ, representing only 4 percent of all types of organ transplants. Fewer than 2,000 lung transplants are performed on average each year.

Caron Burch, MSN, Stanford's program manager for the lung and heart-lung transplant programs, has more than 20 years of experience working with transplant patients and has seen many procedural changes take place outside the operating room. Computers, special algorithms and the Web now help manage the complicated system of connecting organs with patients and health-care teams. Being able to send images in digital form also speeds the sharing of important information once delayed by the need to physically transport X-ray films. New forms of imaging have also made it easier to know more about the potential transplant organs. Histological compatibility — tissue and blood matching — has also improved, based on research into antibodies that once could threaten a transplant. "Now we can look at specific, complicated immunology," Burch said. "We can do virtual cross-matches to assure compatibility."

All Nix knows is that she can breathe again. She has to live by strict rules about what she eats, when she eats, how much exercise she gets and when she takes medications — but she doesn't mind. "You don't go through all of this not to do what they tell you," she said. "I've truly been blessed. It's a happy ending — and that's what keeps me looking forward."