Hospital Innovations Boost 3-Year Survival From 50% in 2001 to 90% 20 Years Later
For Patrick Alexander, a 60-year-old father of three, his illness started with subtle symptoms like shortness of breath and fatigue. Within a year, he learned he had a rare and deadly lung disease. On his 30th wedding anniversary, he was rushed by ambulance ride to his local Fresno hospital and not long after, transferred to UC San Francisco, awaiting lung transplant. Patrick found out that he would be patient No. 1,000 and became the recipient of healthy transplanted lungs.
“I don’t like to use the word ‘miracle’ because not every patient gets that miracle, but I have received a new lease of life and I feel great,” said Alexander.
Thanks to innovations in surgery and follow-up care, patients transplanted at UCSF, like Patrick, can live a normal life. In 2001, three-year survival for UCSF patients who had undergone lung transplantation was 50 percent. In 2021, it had reached 90 percent. And over the last 20 years, median survival has climbed from 3.5 years to 11.5 years.
Innovations have improved survival include the use of a type of life support called extracorporeal membrane oxygenation (ECMO) during surgery.
“An ECMO machine pumps and oxygenates blood outside the body,” said Patrick’s surgeon Jasleen Kukreja, MD, program and surgical director of the UCSF Lung Transplant Program. “Used in place of full cardiopulmonary bypass, it results in less bleeding and lung injury, and significantly reduces the risk of surgical airway complications."
Anti-rejection drugs and close patient surveillance, both in the days following surgery and the post-discharge period, have also contributed to excellent long-term outcomes, she said.
A program initiated by Kukreja a few years ago, has improved access to donor lungs. The “ex-vivo” lung perfusion process allows the lungs to be kept “alive” outside of the body in an environment that mimics the human body, while they are assessed for transplant suitability for a period of up to several hours.
“As a result of this program, we have transplanted several patients who otherwise would have had a 1 percent chance of receiving a match,” she said.
UCSF was the first in the country to offer an “ambulatory ECMO” program to facilitate mobility for patients waiting for transplant and were too ill to be transferred. The program is staffed by clinical teams that travel to community hospitals to provide care at the patient’s local bedside. UCSF clinicians provide a bridge to lung transplant patients for extended periods of time through skilled use of ECMO.
For Patrick, the journey to his transplant began at UCSF Fresno. In May 2021, idiopathic pulmonary fibrosis was suspected by his pulmonologist, Kathryn Bilello, MD, and within months his symptoms accelerated and the diagnosis was confirmed.
“He would feel overwhelming fatigue, just walking across the room or taking a shower,” a stark contrast from his regular lifestyle with long hours at work and frequent get-togethers with friends, said Allison Alexander, Patrick’s wife.
When Patrick’s short-term survival became dire, Bilello arranged for his transfer to UCSF, where his treatment was overseen by Steve Hays, MD, medical director of the Lung Transplant Program. “Idiopathic pulmonary fibrosis is a relentless, progressive disease in which fibrous scar tissue builds up in the lungs, affecting the ability to provide oxygen. Without a transplant, patients may survive for around three to four years,” he said. “But transplanted patients at UCSF, like Patrick, can live a normal life, with medications to ward off infections, healthy diet and exercise. I would expect Patrick to return to his previous lifestyle in about a year.”
Within a week after surgery, Patrick was nipping around the hospital floor, minus the walker and minus the portable oxygen tank that had been his constant companion in the weeks prior to transplant. He’s making plans again. He will return to work but will resume a lighter workload. And together with Allison, he will resume travel plans, including a trip to Ireland.
“I’ve had a good life – great family, great friends – and now I’m discovering I get to have more of the good life I’ve had before,” said Patrick, who has leaned on his faith increasingly during his illness, as well as the prayers of more than 1,000 friends, family members and well-wishers.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu or see our Fact Sheet.
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