Expanding Advanced Lung Disease and Lung Transplantation Programs at UPMC Children's Hospital of Pittsburgh
December 9, 2024
The Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh is rapidly expanding its care for pediatric patients with complex lung diseases and who may need lung transplantation.
Under the leadership of Levent Midyat, MD, director of the Pediatric Advanced Lung Diseases and Lung Transplantation Programs, the team is working to address the growing need for specialized care in conditions such as pulmonary hypertension (PH) and pulmonary vein stenosis (PVS) — two of the more prevalent, primary conditions which create a need for lung transplantation in children.
Dr. Midyat, who also is an associate professor of Pediatrics at the University of Pittsburgh School of Medicine has directed the programs since joining UPMC Children’s in 2023.
Collaborating with Dr. Midyat in growing and enhancing the programs is division colleague, Jessica Reyes Angel, MD, who joined the Division of Pediatric Pulmonary Medicine in July 2024 after completing her fellowship training at UPMC Children’s. Longtime division faculty, Geoffrey Kurland, MD, professor of pediatrics and past lung transplant program director continues to be member of the team.
Developing the Pulmonary Vascular Diseases Program
The institution has established a Pulmonary Vascular Diseases Program to provide comprehensive care for children with pulmonary vascular diseases. This program integrates a team from interventional cardiology, cardiology, pulmonology, cardiothoracic surgery, cardiac imaging, NICU and cardiac ICU holding bi-weekly meetings to discuss complex cases and develop coordinated care strategies.
"The majority of patients in the past were managed individually by cardiologists and pulmonologists, but we saw the need to form a structured program to ensure that these patients receive specialized, collaborative care," says Dr. Midyat.
The team has also developed specific protocols to screen high-risk infants in the NICU who are discharged with conditions like pulmonary hypertension. The new screening protocols allow for early intervention and so that this patient population receives the necessary follow-up to manage their conditions effectively once they leave the hospital.
Progress in Pediatric Lung Transplantation
While pediatric lung transplantation is declining globally, UPMC Children’s is focusing on providing care for the most complex cases, including those requiring mechanical circulatory support. In the past year, the hospital has performed two lung transplants and a heart-lung transplant.
UPMC Children’s stands as the only center in the United States to perform sequential lung and bone marrow transplants for patients requiring both. One of these lung transplant recipients in 2024 is preparing for a bone marrow transplant from the same donor, scheduled to take place in early 2025. This groundbreaking approach underscores the hospital's dedication to advancing innovative, life-saving treatments.
To enhance patient outcomes post-transplant, the program has adopted new monitoring technologies, such as donor-derived cell-free DNA analysis, immune cell function assays, and home spirometry.
"These technologies allow us to monitor our patients more closely and intervene earlier when issues arise," says Dr. Midyat.
The team is also building a comprehensive data registry for all pediatric lung transplants conducted at UPMC Children’s since 1989.
"Our registry will be central to collaborating with other national and international centers," says Dr. Midyat. "It will help us analyze patient outcomes and refine our approaches to lung transplantation in children."
Ongoing Research and National Collaborations
Dr. Midyat’s team is engaged in several research initiatives, including studies using transcriptomic analysis of post- lung transplant biopsy samples. This work aims to identify markers that could guide new therapies for chronic lung allograft dysfunction (CLAD).
"We are excited about using molecular techniques and machine learning algorithms, to identify new ways to improve transplant outcomes," says Dr. Midyat.
A key part of their research strategy is the development of a multi-institutional database and biobank for pediatric lung transplantation, which will facilitate collaborations with centers like Cincinnati Children’s. This initiative will provide a robust platform for ongoing studies and knowledge exchange.
Accreditation and Future Program Advancements
One of the program’s immediate goals is achieving accreditation for the Pulmonary Hypertension Program. This accreditation will position UPMC Children’s as a leading referral center for complex pulmonary cases.
"We are applying for accreditation for our pulmonary hypertension group and are working on creating a registry for our patients," says Dr. Midyat.
Future plans also include expanding the clinical team by adding an Advanced Practice Provider and a Nurse Coordinator to improve patient care and coordination. Additionally, the program is developing a Post-ICU Clinic, which will focus on reducing readmissions for children with respiratory conditions and improving long-term outcomes.
"By providing continuous care and education to families, we can significantly reduce the likelihood of readmission," says Dr. Midyat.
Although still in development, the Advanced Lung Diseases and Lung Transplantation Program at UPMC Children’s Hospital continues to make progress. The multidisciplinary team's work is positioning UPMC Children’s Hospital as a growing center for pediatric lung disease care and lung transplantation.
"We are still building this program, but the enthusiasm from our team is clear, and we expect to make steady progress in the years to come," says Dr. Midyat.
By fostering collaboration, building infrastructure like patient registries, and implementing advanced care strategies, the program aims to improve care for children with advanced lung diseases and provide long-term solutions for pediatric lung transplant patients.
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