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With lung transplant, 'a whole new life' Golfer returns to job and to the links


Before he became Maryland's first single-lung transplant recipient on Feb. 7, Gordon S. West could barely get up from his desk and walk to the copy machine.

Emphysema had left him short of breath, even with the portable oxygen supply he used 24 hours a day.

Mr. West, 51, said that on his last golf outing 3 1/2 months ago he wound up in a sand trap.

"I got the golf ball out, but I couldn't get myself out. I knew I was in trouble then," said Mr. West.

New surgical techniques have reversed a pattern of failures that had made single-lung transplants less common than the more complicated double-lung and combined heart-lung transplants.

Yesterday, just 17 days after his 3 1/2 -hour surgery at University Hospital in Baltimore, Mr. West grinned broadly as he climbed up and down a set of auditorium steps unassisted and without oxygen. His recovery means the hospital will now make the procedure more widely available.

"It's a whole new life for me, almost a miracle when I think back on it," he said just before checking out and going home to Princess Anne.

His surgeons said Mr. West now enjoys 85 percent of his normal lung function, up from 30 percent before surgery.

He will continue to be monitored for signs that his body may be rejecting the lung, and he will take anti-rejection drugs the rest of his life.

He plans to return to work Monday as a collector for the General Motors Acceptance Corp. in Salisbury, and his doctors expect him to be back on the golf links by summer.

Had his emphysema been allowed to continue destroying his lungs, "he was going to be dead in a year, and he might not have lasted that long," said Dr. Joseph S. McLaughlin, director of cardiothoracic surgery at University Hospital.

Now, said Dr. John C. Laschinger, director of thoracic transplants, Mr. West stands a 90 percent chance of surviving his first post-operative year, and 70 percent chance of surviving four to five years.

"He has a good chance of enjoying an excellent quality of life, and for a prolonged survival as well," said Dr. Lewis J. Rubin, director of pulmonary medicine.

Mr. West was a two-pack-a-day smoker for 20 years, and didn't completely quit smoking until 14 months ago. Heredity may also have played a role; his father died of emphysema at the age of 41.

U.S. surgeons have performed almost 190 lung transplants of all types. About 650 people are on lists awaiting single-lung surgery -- seven of them in Maryland, doctors said. The surgery is available at 45 centers world wide at an average cost of $125,000 to $150,000. It is covered by Medicare and Medicaid.

Single-lung transplants are simpler for surgeons and easier on patients than are double-lung or combined heart-lung transplants. They also make the donor's second lung and heart available to other desperately ill patients.

For years, double-lung and heart-lung transplants had a higher rate of success because the airways on both lungs are cut high in the chest where blood supplies are sufficient to promote healing.

But in single-lung transplants, Dr. Laschinger said, surgeons have to cut below the spot where the airway branches off to each lung. Blood supplies are meager there. That, combined with steroid drugs given to prevent rejection of the donated lung, acted to retard healing of the joined airway. Many patients died when the joined portions decomposed.

In a newly designed technique that is more successful, Dr. Laschinger said, surgeons overlap, or "telescope," the two airways. The surgeons then cover the suture with adjoining tissues that carry a stable blood supply.

Doctors said the single-lung surgery should offer hope to patients with emphysema, pulmonary fibrosis, primary pulmonary hypertension and some congenital heart disease. It cannot replace double-lung surgery in cases of cystic fibrosis or lung cancer, where the remaining diseased lung might spread infection or cancer to the donated organ.

Mr. West's left lung was donated by the family of a young Baltimore man who died from a severe head injury.

Most of Mr. West's lung function is now being carried by his donated lung, which can carry the entire load if necessary, Dr. Rubin said. His right lung, which is "far less" diseased than was his left, will deteriorate, but at a "tolerable rate."

The emphysema had also tripled the blood pressure in Mr. West's lungs, placing a severe strain on his heart, Dr. Rubin said. But the pressure returned to normal during surgery, and any damage to his heart "should be completely reversible."

First diagnosed three years after he left Vietnam, where he served with the Marine Corps, Mr. West's emphysema slowly destroyed the tiny air sacs in his lungs. In the past year, his condition worsened rapidly.

"I'd watch him leave for work in the morning and not know if he would make it to the car," said Mr. West's wife, Shirley. "It's very scary."

Mr. West was on the waiting list for only one month when the donor lung turned up.

By the time he checked into the hospital 2 1/2 weeks ago, "I could just barely walk 15 to 20 feet," he said. After surgery, he felt "really super," with no pain.

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