(146) Development of the Collaboration within the Advanced Lung Disease Meeting on Transplant Referral Process at Virginia Commonwealth University Adult CF Center

Background: Although there are medical management options available for patients with advanced lung disease, lung transplantation is the better option to increase quality of life (1). Prior to 2017, Virginia Commonwealth University (VCU) did not have a process for identifying advanced lung disease (ALD) in Cystic Fibrosis (CF) patients. Our CF Center joined the Cystic Fibrosis Foundation’s Lung Transplant Learning and Leadership Collaborative (LLC) in 2017. We have elaborated on methods to standardize lung transplant referral guidelines and prevent obstacles to the lung transplant referral process. The goal of continuing to be a part of this initiative is to conduct a formal intervention for improving the screening of ALD patients, patient education, and timely transplant referral. For the past few years, we have meetings with Duke and other transplant centers to aim towards building relational coordination, shared knowledge, and effective co-production.

Methods: Patients were identified from within the VCU Adult CF Center and characterized by the severity of their ALD. Patients were first stratified by FEV1. Those who were eligible had a FEV1< 50% and were exacerbation free for at least 50% of the time for 1 year. Between May 2021- March 2022, there were a total of 5 meetings with 3 patients discussed at each meeting. Since 2017, the intervention was composed of 3 elements: implementation of ALD meetings, development of a patient education process, and standardization of a transplant referral process. In 2021, other transplant centers, including Duke, UVA, INOVA, and UPMC, were included virtually during the meetings to assist with decision making and discuss patient updates.

On a monthly basis, advanced lung disease patients at the CF center were discussed as an interdisciplinary team. Once identified, patient education took place. Education consists of discussion in a patient room with physician-defined recommendations. Those who wished to pursue transplant were then referred to a transplant center. Patients who elected out of transplant were still discussed during the ALD meetings to ensure adequate care.

Results: Initially in 2017, we had 45 patients classified as ALD with 19 educated and 23 referred. In 2021, 19 patients were identified as ALD with 16 educated and 16 referred. During the meetings from May 2021 – March 2022, 2 patients had an FEV1< 30%, 4 patients had an FEV1 30-40%, and 2 patients had an FEV1 40-50%. Out of the 8 patients in 2022, 2 patients were given education during this time and 2 patients were referred to UPMC. 5 of the patients are female and 3 are male.

Conclusions: Improving and standardizing lung transplant education and referral process has led to an increase in efficiency at the CF center. The CFF LLC has continued to expand, and we are leading other centers to disseminate these guidelines. We will continue ALD meetings and identifying new areas of improvement to enhance this process. Furthermore, we will guide our team to participate in formal training to sustain the education and timely transplant referral efforts. We hope that our experiences in standardizing these guidelines may serve as a model for other CF centers nationwide.

Acknowledgements:

References: [1] Adegunsoye, A., Strek, M. E., Garrity, E., Guzy, R., & Bag, R. (2017). Comprehensive Care of the Lung Transplant Patient. Chest, 152(1), 150–164. https://doi.org/10.1016/j.chest.2016.10.001