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SUMMER 2006
Heart and Lung Transplantation
Heart Transplantation
UCSF's heart transplant program has seen rapid growth
in the past three years, since the arrival of Charles Hoopes, M.D.,
surgical director of cardiopulmonary transplantation. Twenty-one heart transplants were performed at UCSF in 2005. The program
is unusual in that about 20 percent of patients receive a kidney
transplant along with a new heart. That percentage of combined heart-kidney transplants is higher than other programs in the country, said Hoopes.
"In the past kidney failure was considered a reason not to perform a heart transplant," said Hoopes. "The assumption was
that you had missed the window of opportunity for cardiac transplant once the patient had progressive renal insufficiency."
Programs like UCSF's have demonstrated that is not the case. Combined organ transplant patients can do very well.
The procedure challenges surgeons and heart failure specialists to weigh complex variables. Patients who undergo heart transplants typically are severely ill. By the time they are transplanted, their kidney function is often impaired to some extent, and it is not unusual for heart transplant patients to develop renal insufficiency a few years after they receive their new heart. By transplanting both organs simultaneously, it is possible to improve renal function early on.
But transplanting a kidney in a patient with only moderate renal failure removes a cadaver kidney from a limited donor pool with a long recipient wait list, said Hoopes. It is also not clear if performing a combined heart and kidney transplant offers a survival benefit over performing the transplants sequentially.
Another distinguishing mark of the UCSF heart transplant program is that it is one of a very few programs to have transplanted
patients who suffer severe heart damage from Chagas' disease. This parasitic infection is common in Central America and occasionally
causes severe cardiomyopathy. With a large immigrant population in Northern California, UCSF treats a substantial number of patients
for Chagas'. Of the dozen heart transplants historically performed in patients with Chagas' disease within the United States,
two took place last year at UCSF, Hoopes said.
Although the UCSF heart transplant program has grown over the past three years, recipient waiting lists have declined nationally
during that time while the number of heart transplants performed annually has remained stable at about 2000 each year. Improved medical
management, surgical approaches to heart failure and mechanical assist devices are thought to be responsible for the lower numbers,
said Hoopes. But some heart specialists foresee a surge in the demand for heart transplants in the future as the population ages
and palliative care for symptomatic heart failure becomes ineffective.
Lung Transplantation
UCSF performs about 35 lung transplants each year,
making it one of busiest lung transplant programs in California. Half the lung transplants performed at UCSF are for interstitial
lung diseases, such as idiopathic pulmonary fibrosis. UCSF specialists treat a large number of patients for this disease,
which is often complicated by pulmonary hypertension.
The UCSF program is known for its willingness to evaluate patients who might not meet historical criteria for lung transplantation.
These include patients who are undergoing a second lung transplant, pulmonary fibrosis patients with severe right heart failure, cystic fibrosis patients with drug resistant infections, patients with scleroderma and rheumatological diseases, and patients with acute respiratory decompensation requiring mechanical support.
For more information on lung transplants at UCSF, see the Spring 2005 issue of Inside Surgery at www.ucsfhealth.org/common/pubs/surgery/spring2005.pdf.
Consultations and Referrals
For more information about heart and lung transplantation, please contact Charles Hoopes, M.D., at (415) 353-4145.
Summer 2006 Table of Contents
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