Lung transplant program launched at WUM University Clinical Center

On July 11, a successful lung transplant was done by expert surgeons at the Cardiothoracic Surgery and Transplantology Clinic at the UCK University Clinical Center, WUM Medical University of Warsaw. This is the next step in the development of the strategy to build a powerful transplantation center at our clinical faculty. Experts talked about the details of the surgery and promoted organ and tissue transplantation in general at a press conference. It was also an opportunity to talk to a transplant patient who is now getting ready to go home.

A chance for a second life

Robert Pasieczny went through a severe COVID-19 infection, as a consequence of which respiratory failure developed, caused by pulmonary fibrosis. The symptoms included severe dyspnea and limited ability to undertake even minor physical effort. Pharmacological treatment did not help, and long-term oxygen therapy had to be used. Robert’s life could only be saved by a lung transplant. He was registered as a recipient and waited for the organ for about five months. In July, he was told that a lung was available for him. 
The surgery took about four hours and there were no complications. On the seventh day after the surgery, the patient was transferred from the Intensive Care Unit to the UCK WUM Clinic of Internal Medicine, Pneumonology and Allergology. Thanks to the care of anesthesiologists, Robert is now able to eat, drink, talk and walk by himself. He emphasizes that he can see his health improve. These are small things, but they are making his daily life much easier. He believes that his physical fitness and the condition of the lung are going to return to normal quite soon. Now he’s waiting for the moment to move from a hospital bed to an armchair in his garden. – I’m glad that everything is going well, there are no complications. I love my life, I know that some things are now beyond my reach, but there are so many other gorgeous things around that I can enjoy – he says.
Across the entire population of patients with a lung transplant, there are few cases like Robert’s. Will there be more patients with post-COVID pulmonary fibrosis? 
– This is hard to predict, it is still a new disease that we are all still learning about – prof. Rafał Krenke, Head of the UCK WUM Clinic of Internal Medicine, Pneumonology and Allergology, admits. – We even have a new phrase to call it a ‘post-COVID syndrome’, and it does not just affect the lungs and their functional impairment, but other organs as well. We have had a few patients who have developed fibrosis as a consequence of the infection. But the progress of the disease is unpredictable. Some people experience a severe infection and get well quickly, whereas others have mild symptoms, which then develop into a chronic phase, causing irreversible changes.
Professor Krenke emphasizes that most lung transplant recipients are patients with so-called chronic respiratory failure. It occurs as a consequence of long-term diseases developing for years, such as chronic obstructive pulmonary disorder (COPD), cystic fibrosis (CF), interstitial lung disease (ILD), or pulmonary arterial hypertension (PAH).

Team of experts engaged in transplantation

A lung transplant is among the most difficult procedures in transplantology. A whole group of experts was involved in bringing Robert back to normal life.
Organ procurement was done by: prof. Bartosz Kubisa, Agata Dżeljilji, MD, and Katarzyna Szymańska, surgical assistant. The lung replacement surgery was done by a team of: prof. Bartosz Kubisa, prof. Mariusz Kuśmierczyk, Agata Dżeljilji, MD, Beata Broy-Jasik, MD, anesthesiologist, and surgical assistants: Izabela Galewska and Anna Czajkowska. Other UCK WUM experts were involved as well, including pulmonologists - prof. Rafał Krenke, Joanna Klimiuk, MD, Marta Maskey-Warzęchowska, MD hab., Piotr Bielicki, MD hab., Tadeusz Przybyłowski, MD hab., Katarzyna Błońska, MD, anesthesiologist; prof. Małgorzata Sobieszczańska-Małek, cardiologist, transplantologist and internal medicine doctor, and Krzysztof Zając, transplantation coordinator.
– A lung transplant is a special challenge. Most patients are on long-term home oxygen therapy so we need special, very fast transport to the transplantation facility – said Krzysztof Zając, UCK WUM transplantation coordinator, provincial coordinator of Poltransplant organization for Mazowieckie province, said at a press conference. – Another very important matter is the matching of the potential donor and the potential recipients. The donor’s body size must be consistent with that of the recipient, so we have much less freedom in choosing a donor for a recipient. It was tough, but we made it. It’s a new experience for us, which is going to open the path for us to continue with more surgeries like this.
A lung transplant is also a difficult surgery because of the anesthesia and of what happens after the procedure. The patient should start breathing by themselves as soon as possible. This challenge was professionally dealt with by an experienced team of cardiac anesthesiologists working at the UCK WUM Cardiothoracic Surgery and Transplantology Clinic. 
– The problem with that situation was that one lung was transplanted, so that the lung compliance was very different. Two ventilators were working, one of them ventilating one lung and the other one ventilating another. Robert started breathing by himself already during the second day after the surgery – says Katarzyna Błońska, MD, Head of the Cardiac Anesthesiology Department of UCK WUM Cardiothoracic Surgery and Transplantology Clinic.

Prof. Bartosz Kubisa, Head of the Clinical Thoracic Surgery Department of UCK WUM Cardiothoracic Surgery and Transplantology Clinic: – Unlike the heart, liver or kidneys, lungs are the only organ that is continuously in contact with the outside world. Therefore, they are exposed to viral, fungal and bacterial infections. At the same time, they exhibit strong immunogenic properties (activating the immune system), meaning that strong immunosuppression is needed for a transplant, ultimately causing the immune system to weaken. Treatment of a lung transplant patient means striking a balance between the right immunosuppression and at the same time preventing an infection. If there is too much immunosuppression, we get an infection. If immunosuppression is insufficient, we get a rejection response, which occurred in our patient as well. Fortunately, we were able to deal with it through pharmacology.

Organ transplantation program at UCK WUM

WUM is where the entire organ transplantation program in Poland started years ago. – The first successful kidney transplant in Poland took place in 1966 at the First Surgical Clinic of the Medical Academy, currently General Surgery, Vascular Surgery and Transplantation Surgery Department and Clinic at UCK WUM. Worldwide, the organ transplant program started only a few years ago - prof. Zbigniew Gaciong, Rector, reminded the audience at the conference. – And we are still not behind the best clinics worldwide in terms of results and quality. Moreover, we can even match them in quantitative terms. 

UCK WUM is currently the largest transplantation center in Poland. It performs liver transplants, pancreas, kidney, bone marrow, heart transplants, also in children, and multiple organ transplants in adults and children. In 2023, one in two liver transplants in Poland took place at UCK WUM, and 42% of all pancreas transplant surgeries were done here. In addition, UCK WUM delivered 30% kidney transplants from living donors. Since last year, 12 heart transplants were conducted at our Center, after obtaining the Health Ministry’s approval of such surgeries in July 2022.

It is estimated that in a country of the size of Poland, 200 to 300 lung transplants should be performed each year. Professor Bartosz Kubisa reports that 93 such procedures were successfully completed last year. – Around ten years ago, our patients would still have to travel abroad for organ transplants: to Vienna, Copenhagen or Hannover. I believe there are no patients right now who are forced to search for their options abroad, they get the right care here – he says. – I have been working at WUM Medical University of Warsaw for two years and I am really happy to say that we have sufficiently good facilities to conduct lung transplants.

With the launch of the lung transplantation program, UCK WUM joined the group of six places in Poland where such procedures are carried out. Our experts emphasized that among the various factors determining successful lung transplantation, the distance from the patient’s home to the hospital where the transplant takes place is significant. Robert, who lives near Warsaw, was initially qualified for a transplant outside Warsaw. But with the lung transplantation program up and running at UCK WUM, the procedure location was changed to Warsaw. Our doctors hope that with the future growth of the clinic, care can be offered to a large number of patients living in the central and eastern parts of Poland.

Promoting organ donation

Poland is a country where many patients die without getting a chance to live, which is an organ transplant. Therefore prof. Zbigniew Gaciong, Rector, again called for promoting organ transplantation. For many patients, an organ transplant is the only chance to start living their lives in full again, as transplant patients can function normally, they can work, study, have kids.

This address was supported by prof. Mariusz Kuśmierczyk, Head of UCK WUM Cardiothoracic Surgery and Transplantology Clinic: – This message should be promoted not only with regard to organ donation, but also making the medical circles aware of the existence of such faculties as ours, with the right capability and an experienced team. And that we can make many more such lung transplants.