Lung Transplant

Lung Transplant| They were a mere 13 steps up an ordinary staircase. But they symbolized, ironically, how steeply a man’s life can decline because of illness.

Less than a month ago, it took Mark Tomes five minutes to ascend those steps in his home. He suffered from severe emphysema, the result of a nearly four-decade, two-pack-a-day smoking habit. He routinely required six liters of oxygen to breathe. Physical exertion that most of us think nothing about – like climbing a short flight of stairs, washing pots and pans or even taking a shower – forced him to increase the flow to nine or 10 liters.

“There was no quality of life,” he says bluntly. “I was just hanging on, not living.” But Tomes got what he calls “a new lease on life” Sept. 19 when he underwent a successful lung transplant only days after he went on the waiting list at University of Colorado Hospital.

He was the hospital’s first patient in a clinical trial of a new procedure, called ex-vivo lung perfusion (EVLP), in which surgeons actually remove a lung from a potential donor’s body to inspect it.
Until the trial, they would examine x-rays of the lung, looking for signs of scarring and trauma and measuring partial pressure of oxygen in arterial blood to decide if the organ was suitable.

With the EVLP trial, though, they hook the potential donor lung up to a ventilator and circulate oxygen-carrying liquid through it. It gives them an opportunity to actually see, touch and test the lung to decide if it is viable for transplant.

The closer look could yield big benefits. “It allows us to identify lungs in donors that we might otherwise reject,” says cardiothoracic surgeon Michael Weyant, MD, who performed Tomes’ lung transplant.

Two weeks after leaving UCH, Tomes is recovering nicely. He’s making twice-a-week clinic visits for the first month after the transplant, and is getting infusions to treat a megalovirus, the result of immunosuppressant drugs he takes to ward off organ rejection. Those medications, in turn, have caused some swelling in his feet.

But as he sat at a hospital cafeteria table last week speaking with a reporter, Tomes dwelled mostly on the positive change in his life that occurred in the relative twinkling of an eye.

He’d quit smoking in 2000, but the damage was done. His emphysema landed him in the hospital in 2005 with double pneumonia, after which he went on disability. Prescribed oxygen, his reliance on it increased as his health worsened. The three liters he started on soon doubled as his stamina decreased.

Before the lung transplant, 2011 had been distinguished mainly by a rapidly diminishing sense of hope and two four-day hospital stays, first to treat a bronchial viral infection and then pneumonia.
The disease also ended his work life. Tomes spent 28 years working in lawn service and sales in Omaha, Neb. After moving to Denver in 1998, he installed and programmed phone systems. He was employed by a casino in Blackhawk when his disease forced his retirement and accelerated the downward spiral.

“I’d stand at the sink, cleaning pots and pans,” he recalls, “and couldn’t bend over to put them away without getting out of breath. I’d try not to get down. I’d tell myself ‘It is what it is. You just have to live with it.’ But I had no life.”

After his second hospitalization this year, his pulmonologist referred Tomes to UCH to be evaluated for a lung transplant. He went through the requisite testing, and had been on the waiting list only a day in September when he got a surprise call. There was a lung available for him – Tomes was the only candidate it fit – but the lung transplant would include a new procedure, EVLP, that the hospital had not done before.

“They gave me 10 chances to say no,” Tomes relates. “They told me I could say no all the way until I was going into the OR and it wouldn’t be held against me. I didn’t feel pressured at all. It was my decision to back out at any time.”

He decided to move ahead, in large part because of his trust in Weyant. “I was scared,” Tomes says. “I didn’t know if I was going to live or die. But I had total trust in Dr. Weyant. He was so self-assured in his own skin, and he let me know he would not do anything to me that was not in my best interest.”

The lung didn’t turn out to be viable for transplant, so Tomes went home Saturday, Sept. 17.
He got another call, however, Sept. 19, notifying him that another lung had arrived, this one from a donor in Southern California.

By 1 p.m. he was “stuck in a little room,” waiting for the transplant to begin. But it wasn’t until 11 p.m. that he stood in a shower, lathering himself with antibacterial soap, laboring to breathe. He was so weak his providers moved a bed next to the shower for him.

About an hour and a half later, Weyant came by to see him in pre-op. “He said, ‘The lung looks good. I’ll see you in the OR,’” Tomes says. After a roughly two-and-a-half hour procedure, he awoke at about 4 a.m. with a new lung.

He had just one scare during his eight-day stay, a bout of atrial fibrillation the hospital treated successfully with medication and an electrical shock. “That got me back to normal,” he says, “but it concerned me.”

There have been other bumps in the road that normally accompany a lung transplant. He’s fighting the infection, as well as pain caused by 35 incision staples and two tubes draining fluid. But he has no complaints.

“So what?” he says. “Pain goes away, and it lets you know you’re healing.” He’s also walking around without a longtime, unwelcome companion: his oxygen tank. “I knew the minute I got the ventilator out after surgery I could breathe better,” he says. His oxygen requirement immediately decreased to 2 or 3 liters; he’s now completely off it as long as his oxygen saturation level stays at 90 percent or greater.

Tomes now thinks of his life in terms of what he can do, not what he can’t. He’s considering going back to work, and looks forward to taking up again the woodworking hobby he once enjoyed.
“I’m looking forward to doing normal stuff,” he says. “If I want to drive somewhere, I can just do it.”
And those 13 steps? “I’m getting the strength back in my legs,” he says with satisfaction. “I can go up them – no problem.”