Surgeons custom-fit lungs to transplant patients
DETROIT — Waiting for a lung transplant is hard enough, but waiting for one that fits could take even longer.
"Many of the patients on the waiting list have small lung sizes because of their disease," said Dr. Martin Strueber, a transplant specialist with Spectrum Health in Grand Rapids. "Especially, children have a hard time waiting for a suitable donor graft because of size issues. The organ donors have average lung sizes."
The answer, Strueber has found, is a custom fitting of lungs to recipients.
"It's a technique we learned from adult lung surgery," Strueber said. "It's a technique for reducing the size of patient lungs that have the disease of emphysema. We just modified this technique to use it to reduce oversized lungs for lung transplant patients."
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The results have been shorter wait times for patients who risk death if they are delayed. This year, the Richard DeVos Heart and Lung Transplant Program at Spectrum, where Strueber works, performed 28 lung transplants and had just eight people on the waiting list.
"We want our waiting list to be very short and we want our patients to be transplanted as fast as we can so that we have no mortality on the waiting list," Strueber said. "That's the goal."
The center logged a 93% survival rate for recipients one year after their transplants. One successful recipient was Sidney Whitaker, 66, of Hart. In April 2014, he was diagnosed with idiopathic pulmonary fibrosis, a condition where scar tissue forms in the lungs, causing them to thicken to the point that they can't move oxygen into the bloodstream properly.
After a lung biopsy, Whitaker learned how serious it was.
"You do nothing and you die or you get a transplant," Whitaker said.
On Dec. 31, 2014, he was officially listed on the transplant list and told to keep his phone charged to receive a call and to be ready to get to the hospital within three hours. On Jan. 31, he receive a new lung. But it didn't take.
"The lung just wasn't working," said Dr. Reda Girgis, medical director for the lung transplant program at Spectrum. "That's why it was urgent to get that donor."
About a week later, Whitaker received a new, modified lung that took almost immediately.
"He got through it fairly well," Girgis said. "He's going to have his one-year anniversary in February. He's doing extremely well. He can do basically what he wants."
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Whitaker's wife, Jill, was stunned by how quickly her husband responded.
"He was off oxygen in 24 hours," she said. Two months after his last surgery, he went home.
"I have zero restrictions," said Whitaker, who continues to pick garlic, corn, asparagus and potatoes that he grows on his 10-acre farm and sells at his Many Blessings Market.
Jill Whitaker said she and her husband have become big advocates of the program.
"We got to celebrate our 45th wedding anniversary in July," she said. "I wasn't sure we'd have that."
Strueber said the lungs can be modified in one of two ways to make them fit. One is known as a “lobectomy,” the removal of an entire lobe of a lung before transplanting. The other is what's known as “lung shaving,” surgically removing portions of a lobe.
"If the lung is really too big, it's usually a combination of a lobectomy and the lung shaving procedure," Strueber said. "You can take 40% to 50% of it off. We have like donors being a huge male and then we transplant a small female, 100 pounds or less. It is all doable. It needs to be customized to the chest of the organ recipient."
In addition to being an expert in lung shaving, Strueber is a pioneer in what's known as minimally invasive lung transplants.
"The incisions are just in between the ribs," he said. "The chest bone stays intact."
Strueber was born and trained in Germany and to Grand Rapids two years ago to be part of a growing transplant program there.
"You have a community that needs the research. There is a lot of opportunity," he said. "I found that very interesting and challenging."