Mount Sinai’s lung transplantation program helps patients with advanced lung diseases

Key takeaways:

• The Mount Sinai Lung Transplantation Program has a 180-day survival rate of 88.6%.
• The program uses the lung composite allocation score when selecting transplant recipients.

Since its first transplant in March 2022, the Mount Sinai Lung Transplantation Program has performed a total of 35 lung transplants with a 180-day survival rate of 88.6%, according to a presentation.

“The lung transplant program was planned by leadership to help the expanding patient population with advanced lung diseases where transplant is the only option,” Harish Seethamraju, MD, medical director of the Mount Sinai Lung Transplantation Program and professor of medicine (pulmonary, critical care and sleep medicine) and cardiovascular surgery at the Icahn School of Medicine at Mount Sinai, told Healio.

Seethamraju recently spoke at the Mount Sinai Respiratory Institute Symposium about the lung transplantation program, and Healio caught up with him after his presentation to discuss unique features of the program, factors that are considered when selecting transplant recipients and plans for expansion.

Patient selection, allocation score

According to Seethamraju, the Mount Sinai program has the highest transplantation rates in the region, which is paired with low waitlist mortality.

When selecting patients for transplantation, the program considers timing of referral, the patient’s perception of poor quality of life, anticipated regional wait time and failed alternative therapies.

“Any patient with a lung condition that is progressively getting worse, despite optimal medical prescription, needs to be considered for a lung transplant,” Seethamraju told Healio.

Notably, the Mount Sinai program also considers transplant recipients that are aged older than 70 years, HIV positive and hepatitis C virus positive.

As opposed to the lung allocation score that gives individuals points based on 1-year waitlist survival and post-transplant survival, the lung composite allocation score (LAS) used by Mount Sinai factors in 1-year waitlist survival, 5-year post-transplant survival, candidate biology, patient access and placement efficiency. This score also uses a nonlinear rating scale.

Seethamraju told Healio the characteristics of the LAS allow them to “better distribute the available organs to the most needy patients.”

The timing of transplantation, or the “transplant window,” is also important when evaluating candidates as it is based on the individual’s clinical course.

“The patient needs to be in a reasonable functional status to realize the benefit of surgery immediately,” Seethamraju told Healio.

Care after transplantation

In addition to discussing how patients are selected, Seethamraju highlighted the care Mount Sinai provides to transplant recipients after the procedure.

According to Seethamraju, several complications can occur after transplantation, including rejection of the organ, infections or kidney disease.

Immunosuppression regimens, as well as cytomegalovirus, Pneumocystis jirovecii and fungal prophylaxis are used in management after transplantation.

“Close follow-up by the doctor in clinic every month is crucial following a transplantation,” Seethamraju told Healio.

One unique feature of the Mount Sinai program that comes into play when providing follow-up care is its team made up of experts from multiple disciplines. In order to provide the best care for each transplant recipient, professionals from several different fields come together to make an individualized care plan, according to the program’s webpage.

This webpage also states that the surgeons at Mount Sinai have more than 30 years of experience in lung transplantation and are well versed in the latest research and technology related to the procedure.

When asked about the future of the program, Seethamraju said he hopes it will continue to expand and grow.

“The Mount Sinai Health System has a goal to be the world’s largest lung transplant program,” Seethamraju told Healio.

For more information:

Scott Scheinin, MD, FACS, system director of the Mount Sinai Lung Transplantation Program and professor of thoracic surgery at the Icahn School of Medicine at Mount Sinai, can be reached at scott.scheinin@mountsinai.org.

References:

• Mount Sinai lung transplantation. https://www.mountsinai.org/care/transplant/services/lung. Accessed Oct. 24, 2023.
• Scheinin S, et al. Evaluation and management of the lung transplant candidate. Presented at: Mount Sinai Respiratory Institute Symposium; Oct. 20-21, 2023; New York.