Temple’s lung transplant program has grown consistently over the past decade. In 2020, we performed our 1,000th transplant, putting us in an elite group of centers worldwide.

Temple has the fastest time to transplant rate than any lung transplant center in the region, helping more patients.

 

Fast, Seamless Process

Our transplant team coordinates every step of care, from consultation through to admission, transplantation and post-operative lifestyle care. We offer accelerated transplant evaluations so patients and their families can return home as soon as possible.

Co-Managing Lung Transplant Patients

The Temple Lung Center is committed to keeping you informed about your patients. We have a dedicated team of Key Account Managers who can assist you with the needs of your patients, help you quickly resolve any problems, and coordinate contact with Temple lung transplant physicians and staff.

Lung Transplantation Referral Quick Guide

PATIENT SELECTION
Indications
Lung transplantation is indicated for patients with chronic, end-stage lung disease who are failing maximal medical therapy, or for whom no effective medical therapy exists. Potential candidates would be well-informed and demonstrate adequate health behavior and a willingness to adhere to guidelines from healthcare professionals.

General Contraindications
Absolute Contraindications

• Malignancy: Disease free for < 2 years at the time of referral, with the exception of cutaneous squamous and basal cell tumors.
• Advanced dysfunction of another major organ system (e.g., heart, liver, or kidney).
• Non-curable chronic extrapulmonary infection including chronic active viral hepatitis B, hepatitis C, and human immunodeficiency virus.
• Documented ongoing nonadherence or inability to follow through with medical therapy.
• Untreatable psychiatric or psychological condition associated with the inability to cooperate or comply with medical therapy.
• Substance addiction (e.g., alcohol, tobacco, or narcotics) that is either active or has been active within the last 6 months.

Relative Contraindications

• Disease-free malignancy in the last 5 years, with the exception of superficial squamous and basal cell skin tumors.
• Treated chronic extrapulmonary infection including chronic active viral hepatitis B, hepatitis C grade > 2 by liver biopsy.
• Critical or unstable clinical condition (e.g., shock, mechanical ventilation, or extracorporeal membrane oxygenation).
• Severely limited functional status with poor rehabilitation potential.
• Colonization with highly resistant or highly virulent bacteria, fungi, or mycobacteria.
• Severe obesity defined as a body mass index (BMI) exceeding 35 kg/m2.
• Underweight with BMI less than 18.5.
• Severe or symptomatic osteoporosis.
• Mechanical ventilation. Candidates who are able to participate actively in a rehabilitation program and who have been on mechanical ventilation > 7 days without other acute or chronic organ dysfunction may be successfully transplanted.

Source: International Guidelines for the Selection of Lung Transplant Candidates. 2006 Update – A Consensus Report from the Pulmonary Scientific - Council of the International Society for Heart and Lung Transplantation.

DISEASE-SPECIFIC LUNG TRANSPLANTATION CONSIDERATIONS

Chronic Obstructive Pulmonary Disease (COPD)

• Patients with COPD should be referred for consideration of lung transplantation when they have progressive disease despite maximal medical treatment, are not candidates for lung volume reduction surgery, have a BODE index of 5 to 6, a PaCO2 > 50 mmHg (6.6 kPa) and/or PaO2 < 60 mmHg (8 kPa), and FEV1 < 25%.
• Hospitalization for an acute exacerbation associated with hypercapnia carries a poor prognosis with a 49% 2-year survival.

Guideline for Referral

• FEV1 < 25%

Idiopathic Pulmonary Fibrosis and Non-Specific Interstitial Pneumonia
Idiopathic pulmonary fibrosis (IPF) is also known as usual interstitial pneumonia (UIP). Because patients with IPF die without transplantation (median survival time from diagnosis, 2.5 to 3.5 years), it is important to distinguish UIP from other interstitial lung disorders that have a more favorable prognosis. IPF patients have the highest mortality on the transplant waiting list.

Pulmonary Function and Exercise Capacity

• Forced vital capacity (FVC) of less than 60% of predicted is associated with increased mortality. Some patients with preserved lung volumes may be at similar risk of mortality, as are those patients with lower levels of lung function. Well-preserved spirometry should not preclude referral for transplantation.
• Serial measurement of spirometry provides added prognostic value in UIP patients. A 10% or greater decrement in FVC during 6 months of follow-up identifies patients at significantly increased risk of mortality.
• Oxygen saturation of 88% during a 6-minute walk test (6-MWT) identifies a group of patients at particularly high risk of mortality.

Guidelines for Referral

• Histologic or radiographic evidence of UIP irrespective or vital capacity.
• Histologic evidence of fibrotic NSIP.

Pulmonary Arterial Hypertension (PAH)
Prognostic Factors
Advances in medical therapy have changed the prognosis of PAH considerably. The decision to list for transplant is made when functional status and hemodynamics decline to the point where survival without transplantation is likely to be compromised. Long-term survival data is available for patients treated with intravenous epoprosteno; the effects of new therapeutic modalities on long-term outcome are still unknown. actors associated with a poor prognosis are linked to the degree of right ventricular dysfunction.
Guidelines for Referral

• NYHA functional class III or IV, regardless of ongoing therapy.
• Rapidly progressive disease.

Sarcoidosis
The potential for significant extrapulmonary involvement, such as cardiac, hepatic, or neurosarcoidosis, should be considered. Bronchiectasis with bacterial colonization and aspergilloma(s) are prevalent in such patients. Because sarcoidosis tends to have a chronic and variable natural course, the optimum timing to refer a patient for transplantation is difficult to define. Factors indicating poor prognosis include African-American ethnicity, presence of hypoxemia, pulmonary hypertension, diminished cardiac index, and elevated right atrial pressure. An elevated right atrial pressure indicates severe right ventricular dysfunction and is an ominous prognostic factor associated with high short-term mortality. Recent studies have revealed high mortality rates from 30% to 50% in sarcoid patients on a lung transplant waiting list, not unlike mortality rates observed in patients with pulmonary fibrosis.
Guideline for Referral
• NYHA functional class III or IV.

LUNG TRANSPLANT PROGRAM LEADERS

Francis C. Cordova, MD
Professor, Thoracic Medicine and Surgery,
Lewis Katz School of Medicine at Temple University
Medical Director, Lung Transplantation Program,
Temple University Hospital

Gerard J. Criner, MD, FACP, FACCP
Chair and Professor, Thoracic Medicine and Surgery,
Lewis Katz School of Medicine at Temple University
Director, Temple Lung Center

Norihisa Shigemura, MD, PhD
Associate Professor, Surgery,
Lewis Katz School of Medicine at Temple University
Surgical Director, Lung Transplantation,
Temple University Hospital
Surgical Director, Lung Failure,
Temple University Hospital

OUR COMMITMENT TO COMMUNITY PHYSICIANS

At Temple, we believe that quality patient care requires not just experienced clinicians and state-of-the-art technology, but also strong relationships with our community physicians. It is our goal to provide timely and ongoing communication throughout your patient’s evaluation, education, and treatment until he or she is returned to your care. When a patient is amenable to transplant as a treatment option, please consider an early referral to our program. This will allow for proper evaluation and patient education in addition to clear coordination with you, the community physician. 

KEY ACCOUNT MANAGERS
Temple Key Account Managers are always available to assist you and can be contacted anytime to:

• Answer questions immediately
• Help you resolve problems quickly
• Coordinate contact with Temple Lung Transplant Program staff
• Provide information about clinical programs and research studies
• Make a personal visit to your practice

TK Broderic
Director,
External Accounts
m: 267-608-8433
e: Thomas.Broderic@tuhs.temple.edu

Julia Rizzuto
Key Account Manager,
NJ/DE
m: 267-990-5193
e: Julia.Rizzuto@tuhs.temple.edu

Sean Borden
Key Account Manager
m: 267-800-3490
e: Sean.Borden@tuhs.temple.edu