As the only medical center in central Ohio offering lung transplantation for adults, the Comprehensive Transplant Center at The Ohio State University Wexner Medical Center manages an increasingly complex cohort of cases.
“Since the center’s first lung transplant in 2013, we’ve continued to enhance treatments and add the advanced technology needed to help people with more challenging diagnoses,” says Justin Rosenheck, DO, a pulmonary disease and critical care specialist and clinical assistant professor of Internal Medicine in The Ohio State University College of Medicine. “Such improvements in care have led to increasing volumes, with 55 lung transplants completed in 2023 followed by more than 60 from January through November 2024. But more importantly, our outcomes consistently meet national standards even as we’ve added volume and taken on increasingly complex cases.”
Among the capabilities that Dr. Rosenheck highlights are Ohio State’s status as one of the few locations statewide to offer adult extracorporeal membrane oxygenation (ECMO) to patients with end-stage pulmonary disease.
“When it comes to transplant, it can take time to find a match. ECMO has given us the ability to stabilize the most acutely ill patients, and optimize them for transplant success,” he says. “There’s also ex-vivo lung perfusion, or EVLP, which allows us to repair and resuscitate more donor lungs. Both technologies have turned the numbers in a positive direction.”
Ohio State researchers have also explored the use of electrical impedance for noninvasive measurement of lung quality as assessed by tissue edema in an animal model of normothermic EVLP.
Ohio State successfully performed retransplantation for multiple lung recipients, was one of the first centers in the nation to perform COVID-19-related double lung transplants and has invested in an Organ Recovery Team with eight organ recovery specialists and a surgeon working to manage all logistics of organ assessment, recovery and transportation from across the country. Each day, the team reviews 15-20 organ offers, including those for lungs.
The benefits of multidisciplinary care
“Even patients who don’t require use of advanced technology like ECMO or EVLP face unique challenges,” Dr. Rosenheck says. “Our goal is to identify and mitigate these risks well before a person gets the call that a donor has been found.”
Among the members of a person’s care team may be a pulmonologist, a surgeon, registered nurses serving as pre- and post-transplant coordinators, a social worker, a transplant psychologist, a financial coordinator, a respiratory therapist, a dietitian, physical and occupational therapists, a pharmacist and palliative medicine specialist – all with transplantation experience.
To further improve outcomes, pretransplant testing includes screening for vaccination status, overall health and physical conditioning, cardiac assessment, bone density testing, dental clearance and tests for gastric and esophageal function. Targeted care continues post-transplant with a dedicated internal medicine hospitalist team that works with transplant pulmonologists to provide specialized care for people who are readmitted to the hospital at any time post-transplant.
“All the technology in the world can’t replace personalized care or help a person with the many lifestyle and health factors that influence outcomes,” says pulmonology disease and critical care specialist Bronwyn Small, MD. “Our multidisciplinary approach makes it possible for Ohio State to accept more medically complex patients. Most lung transplant programs only accept about one of every 10 persons referred. We’re able to transplant about one of every six.”
As an example of the program’s focused specialization, she cites Ohio State’s expertise in identifying and managing rapidly progressive interstitial lung disease and other acute lung diseases that require rapid transplantation – sometimes developing into a life-threatening situation in just a few weeks.
“Given how quickly these conditions develop, they can be difficult to even identify, so we’re especially vigilant and have learned how to rapidly diagnose these kinds of conditions and effectively transition care to the transplant team to save more lives.”
Researching breakthroughs
Ohio State’s Comprehensive Transplant Center conducts basic, translational and clinical research. This includes several industry-sponsored studies on investigational medications to prevent allograft rejection, which is the leading cause of transplantation failure, as well as advanced rehabilitation research to evaluate the benefit of enhanced physical conditioning prior to surgery and ongoing respiratory therapy post-transplant.
Dedicated transplantation labs include both the Bumgardner Laboratory and Schenk Laboratory, which investigate transplant immunobiology, and the COPPER Laboratory (Collaboration for Organ Perfusion, Protection, Engineering & Regeneration).
Research partnerships occur across departments at The Ohio State University and with other health care centers. Recent publications include:
- Donor-derived cell-free DNA is a valuable monitoring tool after single lung transplantation: Multicenter analysis
- Thoracic retransplantation: Does time to retransplantation matter?
- Early Extubation: Who Qualifies Postoperatively in Lung Transplantation?
- Long-Term Survival Following Primary Graft Dysfunction Development in Lung Transplantation
“We’re always looking for opportunities to collaborate with other centers, and we encourage any interested researchers to contact the Division of Pulmonary, Critical Care and Sleep Medicine or refer patients to our clinical trials,” Dr. Rosenheck says.
Division research programs include those for lung transplantation, as well as for:
- Airway and environmental lung diseases
- Critical illness – acute respiratory distress syndrome and sepsis
- Interstitial lung diseases
- Lung aging
- Pulmonary vascular biology and disease
- Sleep medicine research program
“Our division also encourages research opportunities to our learners,” Dr. Small says. “Undergraduate and graduate students, postdoctoral scholars and clinical fellows can participate in local, national and international conferences and workshops, and we provide ongoing mentorship to help those who are interested in developing their research skills further.”
Ohio State also offers an NIH-funded T32 Postdoctoral Research Training Fellowship in the Biology of Aging and Lung Diseases with three years of structured training for postdoctoral fellows from MD or PhD backgrounds.
Learn more about innovations in care and research from the Division of Pulmonary, Critical Care and Sleep Medicine.