Ex Vivo Lung Perfusion for Transplant

Cystic Fibrosis Podcast 186:
In the latest edition of The Path Forward with Cystic Fibrosis, Dr. Frank D’Ovidio – the Surgical Director of the Lung Transplant Project and Director of the Ex Vivo Lung Perfusion Program at CUMC – explains exactly what the Ex Vivo program is and what its end goals are.
Because so many donor lungs are damaged at the time of death, only 20-30% of donated lungs are usable for transplantation. The ex vivo lung perfusion (EVLP) is a process of evaluating and preparing donor lungs outside the body prior to transplant surgery. In EVLP, the lungs are warmed to normal body temperature, flushed of donor blood, inflammatory cells and potentially harmful biologic factors, and treated with antibiotics and anti-inflammatory agents.
Eventually, as this process is perfected, it could expand the available donor pool by restoring and repairing donor lungs that have sustained damage and eventually create a sort of ‘ICU for organs.’

This video podcast was made possible through an unrestricted educational grant from Columbia University Medial Center and the Lung Transplant Project.

CF Patients, Especially Post-transplant, at High Risk of Gastrointestinal Cancers, Study Finds

By Patricia Inacio

Patients with cystic fibrosis (CF) are at higher-than-average risk of developing gastrointestinal cancers, especially those who underwent a lung transplant, a new study shows.

Transplant patients with CF were found in this retrospective study to have a five-times greater risk of gastrointestinal cancer than those who have not had a transplant, the researchers found, emphasizing a need for careful screening for small intestine and colon cancers particularly, but also for biliary tract and pancreatic cancers.

The study, “Risk of gastrointestinal cancers in patients with cystic fibrosis: a systematic review and meta-analysis,” was published in the journal The Lancet Oncology.

More effective therapies developed in the last 30 years has significantly improved life expectancy for CF patients, with 70 percent of all patients in developed countries expected to reach adulthood. Treatments now in use range from pancreatic enzymes, to antibiotics targeting the bacteria Pseudomonas (a major cause of CF lung infections), to lung transplant surgeries.

But improvements in life expectancy — prior to 1980, most CF patients died in infancy — has brought an awareness of comorbidities in this population. Reports of cancers in CF patients have also risen since 1980, the study notes.

An international team of researchers conducted a systematic review and meta-analysis of studies published in six different databases — PubMed, Medline, Google Scholar, Scopus, Embase, and Cochrane — to investigate the incidence of CF and gastrointestinal cancers. Additional sources included scientific meetings and studies mentioned in the bibliographies of selected studies.

Their search identified six cohort studies including a total of 99,925 CF patients with a gastrointestinal cancer diagnosis. The studies included those who had undergone a lung transplant and those who had not.

Results showed a significantly higher risk of gastrointestinal cancer in CF patients than in the general population, including site-specific cancers — namely, those of the small intestine, colon, biliary tract (the tubes transporting bile produced by the liver into the small intestine), and the pancreas.

In lung transplant patients, the overall risk a gastrointestinal cancer was five times higher than those without a transplant.

Compared to the public-at-large, all CF patients had 20 times higher risk of cancer of the small intestine, and 10 times higher for colon cancer.

“Our results support the CF Foundation Task Force recommendation to initiate colon cancer screening at age 40 years, with repeat screening every 5 years thereafter and 3-year surveillance intervals,” the researchers wrote, recommending the small intestine also be examined in the colonoscopy given.

They also proposed a screening strategy for biliary tract and pancreatic cancers with specific imaging techniques, and a blood test for a cancer protein (antigen 19-9) to be performed every two-to-three years for 40-year-old patients who have not had a transplant, and every one-to-two years who those who have.

For original article please visit CF News Today. 

I’m on the transplant list, now what?

In Jerry Cahill’s latest edition of The Path Forward with Cystic Fibrosis, Dr. Selim Arcasoy from Columbia University Medical Center discusses what happens once a patient is on the transplant list.
The first three major steps are:
  1. Create a strict exercise program with the hospital rehab center and integrate it into the patient’s schedule.
  2. Meet with a nutritionist in order to maintain proper weight.
  3. Educate! Meet with the care team in order to understand the entire process – both pre and post transplant.
The transplant process is a long one – and thoroughly detailed – in order to increase the chances of success. Tune in to learn more from Dr. Arcasoy.

This video podcast was made possible through an unrestricted educational grant from Columbia University Medial Center and the Lung Transplant Project.

A Letter To My Donor

Jerry Unplugged: A blog by Jerry Cahill

Six years ago, on April 18, 2012 I received the ultimate gift – a healthy set of lungs.  

This is my transplant story and finally, an open letter to my donor Chris who gave me a second chance at life. 

On April 17th I was called to Columbia University Medical Center (CUMC) in New York City. They had a perfect set of lungs on paper for me and simultaneously while I was on my way in, a team went to harvest and evaluate these lungs, which were located out of state.  It’s a bit of coordination for the doctors to determine the health of the lungs. Were they damaged? Were there contusions or other imperfections? Were these lungs meant for me? The team at CUMC would make the final decision on whether they were a match or not. It was the sixth time that I’d been called in for the transplant, so I wasn’t getting too excited, but I also didn’t let myself get too down. This time the news was good – the transplant was a go! Before I could blink, my team began to prep me. My worn out, diseased lungs were about to be replaced with clear, healthy lungs. My life was about to be forever changed.  

Before I went into surgery, my lung function was at a dismal 19% and I spent eighteen hours a day pumping myself with medications and intravenous antibiotics to stay alive.  This wasn’t me. I was a coach, an athlete and an advocate for living a healthy life with cystic fibrosis. This wasn’t healthy! My quality of life was non-existent, and quite frankly, I was embarrassed each time I struggled to walk up a flight of stairs.  

As I was wheeled into the operating room, I remember saying to my family, “Go into the waiting room and wait. I’ll see you later.” What was I thinking?   

When I woke up I truly was a changed man.  It was a foreign feeling  for me to have clear lungs and when I took my first breaths I told my surgeon, “these lungs are too big – I think you stuffed them in.” This wasn’t a joke, I was being serious.  I was grateful and knew this wouldn’t just be a second chance at life for me, but for my donor Chris.  We were in this together now. 

The last six years have been quite a journey – and that’s very much how I view life – as a journey.  I’ve written letters to my donor’s family each year, but they haven’t responded yet. I wholeheartedly respect their decision, but I felt strongly compelled to write an open letter to this amazing man Chris, who saved my life. 

Dear Chris……

To read Jerry’s letter to Chris, please click here

Cystic Fibrosis Podcast 180: The Pre-Transplant Process

In Jerry Cahill’s latest podcast series, The Path Forward with Cystic Fibrosis, we hear from Dr. Selim Arcasoy from Columbia University Medical Center. He discusses the pre-transplant process by covering the following topics:
  • When should a CF patient consider a lung transplant?
    • When lung function decreases to 30% or below
    • When there is an increased infection resistance
    • When exacerbations resulting in ICU hospital stays become frequent
    • When a patient experiences frequent lung bleeds and collapse
  • What is the transplant listing process?
  • What is the transplant evaluation process?
  • What are some testing and evaluation obstacles, both mental and psychosocial?
  • What is dual listing?
  • What happens when you are actively listed?

This video podcast was made possible through an unrestricted educational grant from Columbia University Medial Center and the Lung Transplant Project.

Stream “Up for Air” Documentary this Month for Free!

Jerry Cahill‘s documentary, “Up for Air”, provides viewers with an inside look at his personal fight for survival while living with #CF. During national #DonateLifeMonth (4/1 – 4/30) use the code: BEANORGANDONOR to watch the documentary for FREE! Tap the link to watch: https://vimeo.com/137872395

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Jerry Unplugged: Bouncin’ Back

Well, here I sit, staring at four walls, unable to ride my bike, work out, coach, or run. I’m stuck here in my apartment for the next two weeks as I recover from a partial knee replacement. This lifestyle is not me at all. I’m frustrated, and it would be easy to get discouraged, but I can’t afford to.
I’ve just listed some of the many things I can’t do, but I’m focusing on what I can and must do in order to live the way I want to live. I must stay focused on the positive and on my recovery. It’s the only way to bounce back to my version of normal.

Continue reading Jerry Unplugged: Bouncin’ Back

Introducing Jerry Unplugged!

We are thrilled to announce that Jerry Cahill has launched, Jerry Unplugged, a new blog segment on his site.  Jerry is a Delta F508 and R117H #CF patient who is post double-lung transplant by 6 years this April! Not only is Jerry an advocate for #CFAwareness, but he is a coach, athlete, and friend! Join him on his journey as he shares his insights, experiences, and explains why he cannot fail❗
Stay tuned for much more of #JerryUnplugged!

Read the first blog here: http://www.jerrycahill.com/who-am-i/

Continue reading Introducing Jerry Unplugged!

Only I Can Look Into My Mirror

Guest Blog By: Brennen Reeves

If I were to count all of the scars on my body, the ones visible to a bystander at the beach, I’d need your fingers and toes, plus mine. And someone to mark the tallies. Thirty-eight. I’ve counted. From my chest, to my stomach, up to my neck, and down to my ankles the grooves are endless it seems. I don’t think I have any on my back but then again I cannot see my back and I still have trouble with sensation from the bilateral lung transplant I received in 2011, so I wouldn’t be able to feel them either. Continue reading Only I Can Look Into My Mirror

Cystic Fibrosis Wind Sprint 65: Exercising Outdoors Post-Transplant

As all post-transplant patients know, exercising outdoors can be a daunting task because of the danger of too much sun exposure. To solve this issue, Jerry wears lots of sunscreen, a sun-blocking hat, and often works out using a medicine ball somewhere in the shade. Working with a weighted medicine ball gives him the flexibility (literally!) to move his workouts out of direct sunlight and into the shade when necessary, allowing him to enjoy a beautiful day outside while protecting his skin from any harm. As Jerry likes to say… no excuses! Get outside and exercise to live, breathe, and succeed with cystic fibrosis!

Continue reading Cystic Fibrosis Wind Sprint 65: Exercising Outdoors Post-Transplant