University of Michigan Health Transplant Center Lung Transplant Program

University of Michigan Health Transplant Center

Lung Transplant Program

U-M Health Transplant Center The Lung Transplant Program is part of the comprehensive Transplant Center at University of Michigan Health, Michigan Medicine, offering transplantation of the cornea, hand, heart, kidney, pancreas, liver and lungs. Because of the high volume, decades of experience, cutting-edge therapies and multidisciplinary teams of specialists, our goal is to provide an opportunity for transplantation to every individual. Patients trusting us with their transplantation receive care from a team of experts who will be with them throughout their journey. This team consists of • • • • •

Transplant Surgeons Transplant Pulmonologists Transplant Psychiatrists/Psychologists Transplant Nurses/Coordinators Physician Assistants and Nurse Practitioners

• Transplant Pharmacists • Social Workers • Dietitians • Financial Counselors • Peer Mentors

In addition to exceptional patient care, the U-M Health Transplant Center is committed to: • • • •

Leading-edge research that will benefit both today’s and tomorrow’s patient Leadership in the development of innovative techniques Education programs related to transplantation Enhanced organ donation awareness aimed at improving the availability of organs

Lung Transplant Program At U-M Health Transplant Center, our experts provide the latest, most advanced treatment options for patients with end-stage lung disease. As the oldest and largest lung transplant program in Michigan, we have contributed to advances in understanding lung disease and lung transplantation through participation in clinical trials, translational research and basic science research.

We offer specialized services including ambulatory extracorporeal membrane oxygenation (ECMO). ECMO is a game-changing alternative to a mechanical ventilator in wait-listed patients with respiratory failure as it allows them to remain awake and active while awaiting lung transplant.

We also offer services not widely available in the state such as ex-vivo lung perfusion (EVLP), a procedure allowing the transplant team to more thoroughly evaluate the lungs outside of the donor patient while minimizing swelling in the donor lungs, potentially increasing the supply of donor lungs and reducing the waiting period for our recipients.

With more than 800 lung transplantations to date, our current patient survival rate is 92.65 percent one year post-transplant and 79.50 percent three years post-transplant.

These numbers are higher than national survival rate averages. Studies have consistently shown that patients transplanted at high-volume centers (more than 20 lung transplants a year) have better patient survival rates than those transplanted at lower-volume centers.

LUNG TRANSPLANT TEAM

Thoracic Surgeons The University of Michigan Health lung transplant team is comprised of foremost experts in endstage lung disease and transplantation. Our team of transplant surgeons, lung disease specialists and their support staff have advanced training in the treatment of lung disease. Additional team members include transplant coordinators, nurses, physician assistants, nurse practitioners, social workers, the nutrition team, the transplant pharmacy team and financial counselors.

Working collaboratively, they offer experienced and compassionate care to patients in need of lung transplantation after failing medical therapy with conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, interstitial lung disease, sarcoidosis, and pulmonary hypertension.

We offer subspecialty medical expertise supported by nine lung transplant pulmonologists within the Division of Pulmonary and Critical Care Medicine.

Our world-renowned thoracic surgical experience extends to lung transplantation, lung volume reduction surgery, robotic lung resection, esophageal surgery, surgical ICU care and extracorporeal membrane oxygenation (ECMO) for patients in refractory respiratory failure.

Our team also works closely across disciplines with heart, pulmonary hypertension and rheumatology specialists.

LUNG TRANSPLANT TEAM

Thoracic Surgeons The Section of Thoracic Surgery is one of the oldest thoracic programs in the country and has had a long history of innovation in the treatment of surgical diseases of the chest including the resection of esophageal cancer, robotic surgery, and complex airway surgery including sleeve resection for lung cancer and tracheal resection. We perform over 1,000 operations annually. Patients come to U-M Health for the skill and expertise of our team and the advanced therapy options we provide, including: • Lung transplantation: Our program, which has performed more than 800 lung transplants, is the oldest and largest in Michigan with the first revolutionary effort at lung transplantation in the state in 1969. With $14 million in NIH funding, the Department of Surgery continues to expand our research initiatives with the goal of enhancing the quality of life of our patients.

• Lung volume reduction surgery (LVRS): Patients with severe emphysema who are not yet transplant candidates may benefit from LVRS. We are one of only 26 centers approved by the National Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) to perform surgical LVRS for emphysema patients and were part of the landmark National Emphysema Treatment Trial (NETT) demonstrating significant benefits in selected patients with emphysema.

• Extracorporeal membrane oxygenation (ECMO) and ex-vivo lung perfusion (EVLP): ECMO is a specialized technology that can provide mechanical circulatory support for the heart and lungs before or after lung transplant and can help sick patients on the waitlist stay off the ventilator, so they do not get too deconditioned, until donor lungs are available. We also offer services not widely available in the state such as EVLP, a procedure allowing the transplant team to more thoroughly evaluate the lungs outside of the donor patient while minimizing

swelling in the donor lungs, potentially increasing the supply of donor lungs and reducing the waiting period for our recipients.

• Bronchoscopy procedures: Through the use of bronchoscopy, our specialists are able to diagnose lung abnormalities (obtain fluid samples or tissue biopsies for testing), perform minimally invasive procedures to treat tumors, bleeding or inflammation in the lungs or airways, and implant stents in the airways to improve the quality of life for patients with narrowed airways.

Surgical Director Jules Lin, M.D.

Kiran Hari Lagisetty, M.D.

Andrew Ching-Hung Chang, M.D.

William Robert Lynch, M.D.

Rishindra Mamidi Reddy, M.D.

Elliot Wakeam, M.D.

LUNG TRANSPLANT TEAM

Transplant Pulmonologists Pulmonary Overview U-M Health transplant pulmonologists play a critical role on the Lung Transplant team. Our transplant pulmonologists bring unparalleled expertise to all aspects of lung transplantation, with many having extensive knowledge in specialty areas such as cystic fibrosis, interstitial lung disease and research, among others.

Our dedicated team of doctors, advanced practice providers and coordinators offers unique inpatient and outpatient transplant services not available at other hospitals. This team-based approach sets us apart and drives our commitment to improving quality and longevity for our patients

Medical Director Dennis Lyu, M.D.

Elizabeth Belloli, M.D.

Steven Gay, M.D.

Our focus extends to a thorough evaluation to ensure the patient is a viable candidate for a transplant. We also provide patient education and comprehensive care prior to surgery as well as post-transplant critical care, monitoring of lung function, and identifying signs of rejection.

Michigan Medicine is one of the top pulmonary research centers in the world, with a number of available clinical trials that encompass all patients with end-stage lung disease as well as those who have received a lung transplant. The goal of our research is to improve lung transplant outcomes, enhance current therapies and discover new therapies.

Kevin M. Chan, M.D.

MeiLan Han, M.D.

Michael Combs, M.D.

Vibha Lama, MBBS, M.S.

Kevin Flaherty, M.D.

Rommel Sagana, M.D.

ADVANCED PULMONARY DISEASES

Advanced Lung Disease Program

The U-M Health Advanced Lung Disease Program is a nationally recognized program dedicated to enhancing the quality of life for our lung disease patients. Our multidisciplinary team of lung specialists offers comprehensive evaluations and treatment options for patients with irreversible lung disease, including emphysema, COPD, interstitial lung disease, pulmonary hypertension and cystic fibrosis.

Our renowned specialists provide a full spectrum of care for these challenging and complex diseases including: • Expert evaluation and diagnosis of each patient.

• Advanced medical and surgical treatment, including non-invasive endobronchial procedures.

• Comprehensive pre- and post-care for patients requiring lung transplant.

• Collaboration with primary care physicians.

Our adult Cystic Fibrosis Care Center, accredited by the Cystic Fibrosis Foundation, is staffed by six pulmonary physicians and operated in conjunction with U-M Health C. S. Mott Children’s Hospital’s pediatric cystic fibrosis program. Research reveals that patients treated at a certified cystic fibrosis center have more positive outcomes.

Investigators at Michigan Medicine are also actively involved in multiple research studies to understand, diagnose and develop new treatments for advanced lung disease. Clinical trials are an important part of our program and can provide patients with access to novel treatment therapies before they are widely available.

COPD • Philip Choi, M.D. • MeiLan Han, M.D. • Wassim Labaki, M.D. • Michael Sjoding, M.D. Cystic Fibrosis • Michael Coffey, M.D. • Cyril Grum, M.D. • Yvonne Jean Huang, M.D. • Shijing Jia, M.D. • Richard Simon, M.D. • Thomas Sisson, M.D. Interstitial Lung Disease • Elizabeth Belloli, M.D. • Kevin Flaherty, M.D. • David O’Dwyer, M.D. • Jamie Sheth, M.D. Interventional Pulmonology • Jose Cardenas-Garcia, M.D. • Mohammed Ali, MBBS, M.S. Rare Lung Disease • MeiLan Han, M.D.

ADVANCED PULMONARY DISEASES

COPD Program

The U-M Health COPD Program offers the multi-disciplinary expertise of physicians, nurses, respiratory therapists, social workers and nutritionists all available at the point of care.

We have developed a standardized assessment but are prepared to develop individual therapy plans to meet the needs of individual patients.

Our program is equipped to care for a wide range of patients, including the newly diagnosed, those who may have recently been discharged from the hospital and those in need of lung volume reduction surgery and lung transplantation.

U-M Health is one of only a few hospitals in the state to offer the Zephyr® Endobronchial Valve procedure for COPD/emphysema patients.

During this minimally invasive procedure, a bronchoscope is used to place tiny valves in the airways of the lungs, allowing healthy portions of the lungs to expand, lifting pressure off the diaphragm to enhance breathing.

Philip Choi, M.D.

MeiLan Han, M.D.

Pulmonary rehabilitation is critical to the care of COPD patients. Our program brings together a dedicated team of experts to provide a supportive and compassionate environment to help patients with all types of pulmonary disease reduce their symptoms and improve the quality of their lives.

To this end, we also offer smoking cessation and nutrition counseling to our patients.

Investigators at Michigan Medicine are actively involved in helping to understand, diagnose, and develop new treatments for COPD. Leading-edge research studies and clinical trials are regularly available to patients who qualify. Evaluation also includes referral to our lung volume reduction surgery, endobronchial valve, and lung transplant programs if needed.

Wassim Labaki, M.D.

Michael Sjoding, M.D.

ADVANCED PULMONARY DISEASES

Interstitial Lung Disease Program

The U-M Health Interstitial Lung Disease Program specializes in obtaining an accurate diagnosis and recommending appropriate therapy by bringing together a multidisciplinary team of specialists from pulmonology, rheumatology, cardiology, radiology and pathology.

Interstitial lung diseases (ILDs) are difficult to diagnose, requiring a range of tests and approaches. With more than 100 diseases characterized as ILD, an accurate diagnosis is vital.

Because the path that interstitial lung disease takes can be extremely variable for each patient, treatments are still being developed to make the greatest impact on the lives of our patients.

Regular meetings of the Interstitial Lung Disease Program physicians allow for the rapid adjustments that can be necessary in patient care. New patient cases are presented during weekly meetings to determine diagnosis, appropriate therapies and the potential for participation in a clinical trial.

The program actively coordinates with a patient’s home-based physician to carry out therapies and to ensure ongoing communication.

Many of our team specialists are also part of the U-M Health Lung Transplant Program, which ensures seamless movement to this next step in therapy if it becomes necessary. We are involved in determining whether a patient is a candidate for

Elizabeth Belloli, M.D.

Kevin Flaherty, M.D.

transplant and, if so, getting the patient physically prepared. Our goal is to provide continuity of care for these patients, following them all the way through treatment.

In addition to clinical trials and improved diagnostic methods, the Interstitial Lung Disease Program is committed to finding new therapy options for patients through scientific research. Basic cellular research related to the pathobiology of interstitial lung disease has been successfully translated to a clinical study based at Michigan Medicine.

Research and clinical progress is actively translated across disciplines with a common goal of bettering the understanding, diagnosis and treatment of interstitial lung disease.

Research surrounding diagnostic methodology by physicians from the Interstitial Lung Disease Program was published and set the standard of a multidisciplinary approach for ILD diagnosis nationwide. Physicians from our program are also members of an international task force charged with writing guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis.

In addition to ILD, our Rare Lung Disease Program provides specialists in the diagnosis and treatment of patients with lymphangioleiomyomatosis (LAM), Birt-Hogg Dubé syndrome and pulmonary alveolar proteinosis (PAP).

David O’Dwyer, M.D.

Jamie Sheth, M.D.

ADVANCED PULMONARY DISEASES

Interventional Pulmonology Program Interventional pulmonology has revolutionized the field of pulmonary medicine by providing the most advanced, minimally invasive procedures to diagnose and treat both benign and malignant disorders of the lungs and airways.

The Interventional Pulmonology (IP) Program at U-M Health brings together a multidisciplinary team of pulmonologists, radiology oncologists, thoracic and neck surgeons and radiologists to provide resources and leading-edge treatment options not available at other hospitals. Working in a collaborative environment, we determine the best treatment option based on our comprehensive evaluation of each patient.

Most IP procedures involve some form of bronchoscopy, which enables us to perform minimally invasive interventions using tiny cameras or surgical tools passed through a bronchoscope.

We look for and treat tumors, bleeding or inflammation in the lungs or airways, obtain fluid samples or tissue biopsies for testing, dilate areas and implant stents — all without the patient having to undergo surgery, hospitalization and a long recovery. The U-M Health team is also evaluating new endoscopic techniques to diagnose and treat lung lesions.

For some cancer patients, tumors, bleeding or inflammation associated with the disease can block airways, making breathing difficult. Minimally invasive IP procedures can remove obstructions or implant stents to clear and open the airways.

Another complication of cancer is pleural effusion, which is fluid that accumulates in the space between the chest and lung (called pleura). For this condition we perform outpatient pleural drainage (thoracentesis), placement of long-term tunneled pleural catheters, and in selected cases pleuroscopy to drain pleural fluid, easing pressure so the patient can spend more time at home, while allowing sampling of the fluid and tissue for testing that might guide further therapy.

In addition to lung cancer, we treat non-malignant conditions such as COPD, severe forms of asthma, tracheal and bronchial stenosis related to lung transplantation, inflammation or prior procedures.

In some cases, lung transplant patients may experience complications, including airway stenosis. For this, we offer a balloon endobronchial procedure, dilating and administering drugs to minimize the stenosis, or stenting as a last resort.

Jose Cardenas-Garcia, M.D.

Mohammed Ali, MBBS, M.S.

Accessing Your Patients’ Information at University of Michigan Health The U-M Health Provider Portal is a secure web-based application for referring providers and their staff to access their patients’ medical information. The Provider Portal will provide read-only access to the patient’s medical record in real-time. The homepage also summarizes notifications so that providers have information at a glance, and an In-basket allows Michigan Medicine to send notes, letters and results directly to the provider. There is no cost to referring providers to use the Provider Portal.

Information available to view includes: • Appointment notifications • Admission notifications • Emergency Department notes • Laboratory and radiological test results • Physician/Clinic letters • OR notes • Progress notes • Medication lists • Problem lists • Allergies There are three easy ways to learn more about the Michigan Medicine Provider Portal and enroll your practice.

• Visit www.UofMHealth.org/providerportal to download a User and Site Agreement form.

• Email your request to Providerportal@med.umich.edu. Please state your name, practice name, office address, phone number and your administrative contact.

• Call M-LINE at 800-962-3555 and a customer service representative will assist you.

www.UofMHealth.org/providerportal

University of Michigan Health Transplant Center A. Alfred Taubman Health Care Center 1500 E. Medical Center Drive Ann Arbor, MI 48109 Refer a Patient: 1-800-333-9013 M-LINE Consult Request: 1-800-962-3555

www.UofMHealth.org/transplant

Executive Officers of Michigan Medicine: Marschall S. Runge, M.D., Ph.D., Executive Vice President for Medical Affairs, Dean, University of Michigan Medical School, CEO, Michigan Medicine; David C. Miller, M.D., President, UMHS, and Executive Vice Dean for Clinical Affairs, University of Michigan Medical School; Patricia D. Hurn, Ph.D., Dean, School of Nursing.

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