As soon as Anya was diagnosed with chronic rejection (Bronchiolitis Obliterans Syndrome) in July 2012, we made an appointment down to Duke University Medical Center to see if there was anything they could do to help, or even get the process started for retransplantation. We had read about Campath and RAT-G as treatment options for chronic rejection, so we wanted to see if they could perhaps give Anya this treatment.
At that time, the only thing that we really knew about chronic rejection was that there was no known cure. However, with that said, we found documented transplant patients that have been in chronic rejection for over ten years. The idea was to slow it’s progression with treatment.
After going through the week long Duke evaluation in July 2012, the pulmonary doctor told us that he didn’t think Campath was a good idea, since the stats on Campath were still debatable. We agreed, so he sent us home. The Duke team decided that Anya was not eligible for retransplant yet.
So, what makes a transplant patient eligible for retransplant? Or even a first time transplant patient eligible for their first transplant? Well, that’s a tough question, since there are many diseases associated with the lungs. I can only speak to Cystic Fibrosis and our experience with the retransplant process.
In July 2012, Anya’s FEV1 was around 38%. She had dropped from 100% in November 2011 to the 38% roughly 8 months later. From what I understand, the FEV1 is just one of the measurements that Duke uses to determine whether a patient is eligible for transplant or not. Below 30% FEV1 is the rough number that makes someone eligible.
Another measurement that Duke uses was something called the DLCO (carbon monoxide diffusion capacity). I don’t know what Anya’s DLCO was in July 2012, but in March 2014, it was roughly 53%. Based on this document online, Anya’s DLCO was in the moderate range:
I think anything above 50% and the patient’s 5 year survival rate is greatly diminished. If your DLCO is in the mild range, then it also hinders your transplant eligibility.
Another eligibility factor is the type of disease in the patient. I met a few pulmonary fibrosis patients while at Duke, and their disease was progressing so fast that they didn’t think that they were going to be eligible for a transplant.
And the last requirement that I know about is age. I was told that patients over the age of 65 were not eligible for a double lung transplant. I don’t know how accurate this is because the former Vice President, Dick Cheney, received a heart transplant at the age of 71. However, I did read something recently about Duke accepting “select” patients over the age of 65, even over 70 years old.
Most of the stuff above is stuff that I picked up from the Doctors at Duke. I don’t think that there are any definitive numbers for transplant eligibility, just guidelines. Obviously, a lot has to do with the current health of the patient, and whether or not the doctors think that the patient will be able to survive the transplant.
The best thing to do is to schedule an appointment with one of the big Lung transplant centers around the country. I’ve gathered some information about transplant eligibility across the different lung transplant centers in the United States:
- Duke University Medical Center (eligibility info)
- University of Pittsburgh Medical Center (eligibility info)
- UCLA Medical (eligibility info)
- Stanford Hospital and Clinics (eligibility info)
- Cleveland Clinic (eligiblity info 1 | 2)
- UCSF (eligibility info)
- John Hopkins (eligiblity info)
Not all centers are the same, but at Duke, it was a week long evaluation. Then, the following Tuesday, they contact you and tell you if you meet the eligibility requirements or not.