Key Takeaways
- Duke Health helped a patient with rheumatoid arthritis-associated interstitial lung disease by offering him a lung transplant efficiently.
- Advanced age is not an automatic disqualifier for transplant at Duke Health.
- Early referral gives patients the best chance of optimal outcomes.
When a 70-year-old active man with longstanding rheumatoid arthritis (RA) could no longer take the trash to the curb, he knew he had to take action. A family friend recommended he seek a referral to Duke Pulmonology.
The patient was referred to Duke Health pulmonologist Lake D. Morrison, MD, who diagnosed him with interstitial lung disease (ILD), scarring in the lungs as a complication of RA. After a year of treatment, the patient continued to see decreased endurance. The patient’s condition deteriorated enough that it was clear his own lungs would not be able to sustain his life, but the traditional age limit for transplant is 65 years.
How did Duke Health restore this patient to health and activity?
Morrison worked with lung transplant surgeon Jacob A. Klapper, MD, surgical director of the Duke Lung Transplant Program, to prepare the patient for transplant. “At Duke, we transplant many older patients,” Klapper says. “Being older than 70 doesn’t automatically disqualify a patient as a candidate for transplant.”
Klapper notes that the patient was an excellent candidate, as an active and motivated person with specific goals for recovery and good social support. Within six months of the initial tests, the patient had completed lung transplant preparation and suitable donor lungs were located.
Although the patient experienced some setbacks post-transplant including a heart complication that required extracorporeal membrane oxygenation (ECMO) support, the Duke team worked together to treat all issues.
“The nursing team went so far beyond the call of duty to offer me comfort, aid, and support,” the patient says. “Along with my transplant team, they are the reason that I’m alive today.” In the weeks following his discharge, the patient has enjoyed time with his grandchildren and on his boat.
Klapper says the patient was referred at a vital time. “At his age, if he got much sicker, he would be unlikely to do well after transplant. The timing is important: patients have to be sick enough for transplant but not too sick to survive the operation and rehabilitation.”
Early referral ensures patients are connected with Duke before they pass the point where they can recover from major surgery. “It’s never too early to refer for consideration,” Klapper says. “Early referral allows our team to work with patients on modifiable risk factors, help develop their social support system, and puts us in a position to help as soon as they become ready for transplant.”
Refer a patient to Duke Transplant or learn more about lung transplant (PDF).
