As waiting lists for lung transplants grow, so does the demand for robust and trustworthy transplant programs in the United States. Since opening in 2007, University of Iowa Health Care’s lung transplant program has served as a successful model for institutions’ transplant services nationwide. The Scientific Registry of Transplant Recipients (SRTR) recently validated this tradition of excellence, ranking UI Health Care’s program as a nationally top-performing institution in one-year patient survival rates.  

All lung transplant programs in the US are included in the SRTR and ranked according to the following metrics: 

• Waitlist mortality: The rate at which patients die while waiting for a transplant
• Transplant rate: The ratio of observed to expected transplants performed
• Post-transplant survival: Patient survival rates at 30 days and 1 year after transplant
• Risk-adjusted outcomes: Differences in patient populations across centers to ensure fair comparisons 

The registry benchmarks metrics against regional and national averages among the 76 lung transplant programs, indicating where a program performs relative to its peers.  

UI Health Care’s ranking is far from a fluke—instead, it confirms the program’s longstanding success. Iowa’s lung transplant program has maintained its national top 10 status in patient outcomes across nearly two decades and more than 300 transplants performed. Sustaining this caliber of performance reflects a standard of care few programs in the nation can top.  

Building a strong foundation
Driving the program’s continued success are its leadership and a coordinated team of experts. Julia Klesney-Tait, MD, PhD, and Tahaunty Peña, MD, MS, serve as the program’s medical director and associate medical director, respectively; Kalpaj R. Parekh, MBBS, serves as its surgical director. Klesney-Tait and Parekh have led the lung transplant program since its founding.  

Even in the program’s formative years, it matched leadership’s vision. Iowa’s program gained certification from the United Network for Organ Sharing and the Centers for Medicare & Medicaid Services after only 18 months of operation and continues to earn stellar administrative and clinical scores from these agencies. And, year after year, it remains a Blue Cross Blue Shield Center of Excellence in Lung Transplant.   

“The program was designed to marry exceptional clinical care with cutting-edge research. We created a culture of excellence that values patient safety, fiscal responsibility, and research development,” Klesney-Tait said.  

A team-oriented approach
The expert team fostering this culture includes four transplant surgeons, four transplant pulmonologists, a transplant ARNP, four nurse coordinators, two transplant social workers, two transplant pharmacists, and a network of anesthesiologists, rehabilitation specialists, and intensive care nurses. Parekh attributes Iowa’s impressive SRTR ranking to this multidisciplinary team.

“One of the most impactful factors contributing to our top national ranking in one-year patient survival is our multidisciplinary team approach,” Parekh said. “The trust, collaboration, and open communication among our surgeons, pulmonologists, nurses, coordinators, and support staff have created a culture of excellence. Our team’s ability to adapt, combined with unwavering dedication and diligence, has driven the program’s growth and outstanding outcomes.”   

From initial evaluations to long-term recovery, Iowa’s lung transplant program serves its patients through streamlined collaboration, not a series of isolated steps. Surgeons and pulmonologists work closely with coordinators and nurses to tailor treatment to each patient’s unique needs. Pharmacists and social workers develop robust aftercare plans and support systems well before a patient’s operation date. This teamwork not only enhances safety and efficiency but also fosters strong relationships between patients and their care team.   

Excellence in complex care 
The strategic plan structuring the program prioritizes patient outcomes, programmatic volumes, financial solvency, and academic research contribution. These benchmarks serve Iowa’s overarching goal: providing the highest quality care to patients in need of lung transplantation. Klesney-Tait and Parekh established this strategic plan during the program’s inception, steering it away from the national trend at the time of its development—a 44% closure rate for new lung transplant programs. 

While the program’s initial vision has remained the same, Parekh said the team demonstrated its ability to adapt to change, including those within the national organ allocation system. In 2023, organ allocation transitioned from a regional to a national system. It implemented a composite allocation score (CAS), which sought to improve organ access by 1) doing away with geographical boundaries for organ access and 2) prioritizing the most critically ill patients.

“Our program has responded proactively to these changes. We’ve embraced the challenge of listing and caring for some of the sickest patients, and we’ve expanded our geographic reach to procure organs from distant locations when necessary. This flexibility and commitment have been key to our continued success,” Parekh said.  

Peña said that after this change in allocation, Iowa’s operation caseload prioritized transplantation for the most vulnerable patients.  

“When considering these program rankings, UIHC is ranked higher than programs that perform way more transplants than us, programs that you could argue have more experience,” Peña said. “Still, we have better outcomes. We have also been transplanting on more critically ill patients and have a lower margin for error when performing fewer transplants. Yet we maintain great outcomes.”  

Bridging innovation and patient care
Program leadership describes the team’s academic research as a crucial component of strong patient care. Receiving funding from foundations like NIH, VA, and the Cystic Fibrosis Foundation, the team draws on its clinical encounters to pursue research that can improve future care.  

“Our transplant team has published more than 275 articles on clinical, translational, and basic science research over the past 18 years,” Klesney-Tait said. “We have developed a robust lung transplant clinical trials network and, most recently and prestigiously, were invited to be one of 5 enrolling centers for the first ever Centers for Medicaid and Medicare Services (CMS) sponsored trial in lung transplant for the treatment of chronic rejection.”  

Research with high translational value has proved especially important for the lung transplant team in recent years. Since the onset of the COVID-19 pandemic, some patients have developed acute respiratory distress syndrome (ARDS) and post-COVID pulmonary fibrosis. Patients with COVID-related lung diseases account for nearly 10% of current lung transplants, and Parekh said these complications have caused many individuals with previously marginal lung function to require transplant intervention. However, patient outcomes have generally been favorable, with survival rates comparable to those of other transplant recipients.   

Overall, research innovation enables the team to continuously evaluate and improve protocols that improve patient safety, post-operative care, and personalized treatment. These outcomes pay dividends in patients’ lives in immeasurable ways. Ultimately, there is no regulatory metric that can capture just how much UI Health Care’s lung transplant program has improved, and even saved, the lives of its patients.