OMED 2016

Lung transplants: What primary care physicians need to know

Marie Budev, DO, MPH, leads one of the world’s most successful lung transplant programs. Here’s what she wants primary care docs to know.


Organ transplant surgeons depend on primary care physicians to provide follow-up care to their patients after they recover from surgery. Primary care physicians keep transplant patients healthy, update the transplant center on patients’ progress and try to prevent postop complications by alerting the center when concerns develop.

“Primary care physicians are our right hand,” said Marie Budev, DO, MPH, the medical director of the Cleveland Clinic Lung and Heart-Lung Transplant Program, during a Saturday OMED session organized by the Cleveland Clinic and the American College of Osteopathic Family Physicians. “I wanted to share with you some of the challenges we face.”

Dr. Budev’s transplant program is one of the most successful in the world. Her program holds the record for 159 lung transplants in one year, which happened in 2009, she reported. Lung transplants are on the cutting edge of medicine—the first lung transplant ever performed was just over 50 years ago, in 1963. Since then, physicians have worked tirelessly to improve outcomes for patients who receive lung transplants after having end-stage lung disease.

Currently, the five-year survival rate following a lung transplant is 47-57%, Dr. Budev said. This is lower than the survival rate for other solid organ transplants for a few reasons. Physicians still don’t completely understand the best dose of immunosuppressive drugs to give lung transplant patients, and the drugs are harsh and can cause other health problems such as diabetes and kidney disease. Also, the lungs are more vulnerable than other organs because they are constantly exposed to toxins and irritants in the air patients breathe.

On the flip side, some transplant patients, aided by their primary care physicians, do extremely well following surgery and recovery.

Here are a few things Dr. Budev said primary care physicians should know about lung transplants.

  • Primary care physicians should work closely with the transplant center and the patient in an effort to keep the patient healthy and help prevent complications.
  • Common complications include obliterative bronchiolitis, or scarring and fibrosis that obliterates small airways, and acute cellular rejection (ACR). You can work with the transplant center to diagnose these. Patients with ACR must take more corticosteroids, but doing so makes them more vulnerable to malignancy, infection and other complications.
  • It’s a good idea to be familiar with the common drugs transplant patients take and to understand their side effects. Some of them include: tacrolimus, cyclosporine, mycophenolate mofetil (MMF) and corticosteroids.
  • There’s a higher prevalence of malignancy, including melanoma, in lung transplant patients because of the immunosuppressive drugs patients must take.
  • Because these drugs can also cause damage to the kidneys, transplant patients should not take angiotensin-converting-enzyme inhibitors or nonsteroid anti-inflammatory drugs.
  • Patients with hyperlipidemia should be kept on a low dose of statins because a high-dose statin can interact with their anti-fungal therapy.
  • For six months after transplant surgery, patients should not receive live vaccines. Routine vaccines can commence after six months.
  • Transplant surgeons rely on primary care physicians to manage the anxiety and depression that often occur in transplant patients, who were very ill before receiving the transplant and often remain ill for some time following the transplant. “You guys are great at this,” Dr. Budev said.

One comment

  1. Winston Reed

    Dr. Marie Budev: Thank you for that ” What Prmary Physicians Need to Know”article in The DO.
    I want to mention that we are very impressed with your being the Medical Director of the Cleveland Clinic’s Lung and Heart Lung Transplant Program,congradulations on your accomplishment !

    Winston Reed,D.O.,ACOEP

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