Joel Cooper, M.D., has been a key figure in one of the spectacular life-saving achievements in the history of Alpha-1: lung transplantation.
This year will mark the 30th anniversary of the first successful lung transplant performed by Cooper and his surgical team at the University of Toronto Nov. 7, 1983. The patient was Tom Hall, then 58, a Canadian dying of a lung disease called pulmonary fibrosis.
Before Cooper succeeded, lung transplantation had been attempted 44 times worldwide. All the patients died within a few weeks. Cooper had tried and repeatedly failed himself at Toronto General Hospital. He decided to suspend transplants until he could figure out what was going wrong.
He found the culprit by a series of experiments with dogs in his own basic research lab: the steroid prednisone, which was routinely prescribed in high doses to transplant patients. Prednisone fended off organ rejection, but it also interfered with healing.
When cyclosporine, a more powerful anti-rejection drug, became widely available in 1983, Cooper went back to his work with human lung transplants.
Several months after that first successful lung transplant, Hall returned to work and lived for seven years before dying of kidney failure.
First Alpha, first double
Three years after Halls surgery, Anne Harrison became the first successful Alpha-1 recipient and the first patient of any kind to successfully receive two lungs. Cooper performed that first successful double lung transplant in 1986, shortly after he moved to the University of Washington in St. Louis.
After Harrisons surgery, Cooper called his friend Ronald Crystal, M.D., who was then leading the development of Alpha-1 augmentation therapy at the National Heart, Lung and Blood Institute. I told him I had just transplanted this young woman with Alpha-1, and I asked him what I should do.
Crystals answer: Tell her: Dont smoke.
Cooper laughs. It was obvious. But he was pointing out that even a little smoking does a lot of damage to someone with Alpha-1.
Harrison died of a brain hemorrhage more than 14 years after transplant, Cooper said.
His second double lung transplant patient was Doris Matthews, on Jan. 9, 1987. I called her Jan. 9 to congratulate her on her 26th anniversary. Shes doing quite well, still working, I think three days a week. Shes had a kidney transplant, something many long-time survivors of transplant, particularly lung transplant, have had, because of the damage to kidneys from immune system suppressants.
At 26 years, Matthews has survived the longest of any of Coopers lung transplant patients, and he believes she may be the worlds longest-surviving lung transplant recipient.
Since 2005, Cooper has been a professor of surgery at the University of Pennsylvania School of Medicine in Philadelphia. He is still operating as much as ever, he says.
Lung Transplant Survival
Today, many Alphas and other patients who otherwise would have died from end-stage lung diseases are benefiting from lung transplants.
But among transplanted organs, lungs seem especially difficult. The median survival after lung transplant is still only a bit more than five years, the worst of any major internal organ transplant.
Why is that?
Different organs have different propensity for rejection, says Cooper. We all wish other organs were like the liver. You can usually head off rejection in the liver very rapidly, and there are people with transplanted livers who can remain off anti-rejection drugs completely. Probably the worst of all things is skin. (Transplanted skin) rejects the most easily of all. The lungs, like the skin, are directly in contact with the outside environment, forever coming in direct contact with the outside air that harbors many kinds of infection, from viral to bacterial. The kidneys are not like that, or the liver, or the heart. So the problem is the overpropensity of the lungs to reject, and the need for heavy doses of immunosuppressants to stop rejection. Its going to be solved, theres no question.
Future Treatment Of Lung Disease
Cooper was among the first surgeons to revive lung volume reduction surgery removal of damaged portions of the lungs of patients with COPD in the 1990s. Reducing the size of the lungs can improve lung function and help patients breathe easier the only treatment short of a transplant to restore lung function in patients with late-stage emphysema.
He believes that lung volume reduction is underused and underrated today. He is disappointed at the misinformation about lung volume reduction surgery, which really can make a tremendous difference.
One of his special interests is research that demonstrates the difference between types of COPD. He hopes there will be an increased awareness that emphysema is one disease and obstruction and spasm of small airways is another, and I would like to see more focus on not lumping them together as COPD, but recognizing that they may have different pathways and that you need to develop different treatments.
Advice to Alpha-1 Lung Patients
Specifically for Alpha-1, Cooper stands by some suggestions he made in an interview for Alpha-1-To-One magazine in 2006. He still believes that the real frontier for Alpha-1 treatment lies not in surgery, but in the research lab and the physicians office. I was always taught that a surgeons highest achievement was to eliminate the need to operate, he said then. It seems to me that the ideal goal for Alpha-1 treatment is better education and awareness among both physicians and patients, early detection, and better medical management of the disease. We also need to better understand the role of inflammation that sets up tissue destruction.
He gives all his patients (whether Alpha-1 or smoking-related COPD) one consistent message:
Cooper doesnt expect any dramatic improvements in the near future for lung surgery.
Im a surgeon, so of course I believe that surgery has a role, says Cooper. But as an Alpha-1 advocate, I also believe that the immediate future is prevention and medical management.