Tiago Machuca, M.D., Ph.D., surgical director of the Lung Transplant Program and an assistant professor of surgery in the UF College of Medicine, credits the program’s continued emergence as one of the nation’s best to the expertise and dedication of a skilled multidisciplinary team and to its focus on innovative care.

“It was a great year for our lung transplant program, a great year for our patients,” Machuca said. “We’re proud of our team. Every piece of the puzzle has to come together to provide the best possible treatment for our patients. Seeing them recover and doing the things they love and enjoying their lives again is extremely rewarding for us all.”

As the program’s reputation has grown, the numbers have followed, with patients from throughout the Southeast seeking out UF Health, in addition to increased referrals from physicians, he said.

“I think that obviously comes from a huge effort from a very large team that is dedicated to lung transplantation,” Machuca said.
That team includes nurses, physicians, physical therapists, social workers and others.

“We take great pride in the excellence and dedication of our lung transplant team,” said UF Health Shands CEO Ed Jimenez. “Its members have worked tirelessly to make the program one of the nation’s best and continually provide hope to patients who have been turned down elsewhere and look to UF Health as their last chance at life. And our team delivers. That is the definition of great health care.”

Having a large number of patients makes everyone on the team more proficient and better at what they do, said Mauricio Pipkin, M.D., a lung transplant surgeon and an assistant professor in the UF College of Medicine.

“A program should grow and become a sustainable environment,” Pipkin said. “When you start growing, you are not doing that just for the numbers. We need to maintain the same outcomes. We need to provide the care the patients need in the best way. The pace is well-measured.”

UF Health’s lung transplant program was the first in Florida when it started in 1994. While the transplant center was the state’s leading program until about 2008, other Florida hospitals began doing transplants, especially beginning in the early 2000s. (Today, five hospitals perform transplants in Florida.)

With more hospitals competing for donor lungs, it became more difficult for the UF Health program to maintain its numbers. Lungs that had once gone exclusively to UF Health were now being distributed among several hospitals.

By 2014, UF Health performed just 12 lung transplants.
But Machuca, who arrived at UF Health four years ago, and other team members helped spearhead a more aggressive approach to lung transplantation.

“The main characteristic that drives us is that we believe in innovation,” Machuca said. “And we constantly are challenging the status quo.”

One of the program’s key pivot points came in 2015 with the establishment of UF Health’s adult extracorporeal life support program.

The team uses a device widely known by its abbreviated name, ECMO, short for extracorporeal membrane oxygenation. ECMO oxygenates a patient’s blood while removing carbon dioxide, functioning as an artificial lung. ECMO is essential to keep patients alive while awaiting a transplant in case their lung capacity further deteriorates. It also is used during surgery.

Before ECMO, if newly transplanted lungs did not begin adequately functioning in the hours after surgery, often the only way to save a patient’s life was for them to undergo another grueling transplantation with a new set of donor lungs. And that assumed new lungs could be found before the patient died.

“We’ve learned that we don’t need to re-transplant these patients anymore,” Machuca said.

The Extracorporeal Life Support Organization last year awarded UF Health its Gold Level ELSO Award for Excellence in Life Support for its exceptional care using ECMO in adult and pediatric cases.
UF Health also takes a more aggressive approach in selecting donor lungs. About 75 percent of donor lungs nationally are initially deemed unsuitable for transplant because of problems such as impaired gas exchange or pulmonary edema. But those problems often can be reversed by using the XVIVO Lung Perfusion System, a technology that allows the lungs to be kept alive and improved so that they can become eligible for transplant.

In addition, UF Health is one of just a handful of hospitals in the nation where surgeons can resize donor lungs through lobar transplantation. Traditionally, women and men of smaller stature and pediatric patients have waited longer for lungs that will fit their chest properly since donor lungs are often from taller men who have suffered a traumatic injury.

“If you wait for the perfect match to come, the trade-off is that your patient might die,” said Andres Pelaez, M.D., the medical director of the lung transplant program and an associate professor of medicine in the UF College of Medicine. “By offering lobar transplantation, our program can overcome this significant barrier and avoid deaths on the wait list.”

Maria Rodriguez, 71, of Miami, had experienced difficulty with her lungs much of her life. She suffered from chronic bronchiectasis, an infection and inflammation of the bronchi, which are the main passageways of air into the lungs.

By 2017, Rodriguez’s breathing difficulties were becoming desperate.
Another Florida hospital rejected Rodriguez for a transplant, though she said she wasn’t told specifically why. Perhaps it was her age, she said. Aside from the lungs, Rodriguez said she was in excellent shape.

She was considering coming to UF Health, but she was still unsure. She dreaded the thought of the operation.

Before visiting UF Health, Rodriguez went to a South Florida Costco with her husband. Rodriguez, who was on oxygen, noticed a man staring at her. She thought the stranger was being rude. He approached and asked Rodriguez about her breathing condition.

“I was trying to be polite,” she said. “I said, ‘I don’t breathe too good.’”

The man, Norman Gonzalez, told her that he had undergone a successful double lung transplant at UF Health in September 2017 and “started talking wonderful things about” its lung transplant program, Rodriguez said.

Gonzalez looked to be in great shape, which reassured Rodriguez.
“He was the last push for me to not be afraid to do this,” she said. “You see someone talking perfect, walking perfect. It was a great push.”

Rodriguez got her new lungs in March 2018. “Never more in my life will I use (bottled) oxygen,” she said.

Machuca and Pelaez said they hope the UF Health lung transplant program will continue to benefit an increasing number of patients suffering from advanced lung disease. Besides Machuca and Pipkin, the program expects to recruit a third lung transplant surgeon later this year and also add a transplant pulmonologist.

“It’s completely satisfying to see so many patients enjoying life again and families enjoying having a family member back,” said Pelaez. “And at the same time, it is extremely gratifying to see a team working together toward a common cause and looking to identify how we can contribute to and improve the field of lung transplantation.”

One of the patients enjoying life again is Rita de Pastore.
Pastore, a Venezuelan woman who lives in Miami, suffered from pulmonary fibrosis, which hadsavaged her lungs.

By the spring of last year, her condition deteriorated rapidly. From May to June, her need for external oxygen had quadrupled. Pastore was confined to a wheelchair. The woman needed new lungs, and rapidly.

A complicating factor for Pastore was that her condition also necessitated a coronary bypass. Like so many others, she, too, was turned down for a transplant by another hospital. Though she was then only 53, the combined procedures were considered too high risk.
“I was very, very bad,” she said. “I think I had almost no time to live.”

After a referral, Pastore first visited UF Health on July 20. On Aug. 7, a team of transplant surgeons and cardiac surgeons performed a complex double lung transplant with a concomitant coronary artery bypass at the UF Health Heart & Vascular Hospital.
Hers life was transformed. The oxygen was gone; so too, the hated wheelchair.

Seven weeks after she received her new lungs, Pastore’s friends threw a party to celebrate hre new life. She effortlessly danced with her husband.