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The Story of Jimmy Epling - First Heart Transplant at UKMC in 1991

Jimmy Epling
Dr. Sekela and Jimmy Epling (20 years post-surgery)

Written by Eric Gregory
Story and Photo Source: Lexington Herald-Leader
Date: April 2, 1991

Jimmy EplingThe first patient to receive a heart transplant at the University of Kentucky Chandler Medical Center is a 40-year-old Pikeville man, hospital officials said yesterday.

Jimmy Epling, who received the heart last week, was moved yesterday from the intensive care unit into a regular room, said his surgeon, Dr. Michael E. Sekela. He was in serious but stable condition last night.

"Mr. Epling is in good spirits," Sekela said yesterday. "He's walking around and eating and doing everything he needs to do."

"His major concern is that he thinks we're lying to him by telling him he's doing so well. He thinks he should be worse than he is."

Epling underwent the four-hour transplant surgery last Thursday, in the first such operation at the UK Medical Center and in Eastern or Central Kentucky. Three other state hospitals, all in Louisville, have performed the surgery: Jewish Hospital, Humana Hospital-Audubon and Kosair-Children's Hospital.

Yesterday was the first time UK officials had identified Epling by name, age or hometown, a decision Sekela said was his professional policy. "I didn't want to put his family or him into any undue attention," the doctor said.

A Lexington television station had been allowed to videotape the operation and the tape was distributed to other local stations. But until yesterday, Epling had been identified only as a "young man" from Eastern Kentucky.

Epling requested that his name be released, and has agreed to be interviewed by the media later this week, Sekela said.

The hospital yesterday also released a picture of Epling and his wife, Joan. Spokeswoman Mary Margaret Colliver said the couple have six children - ages 10 to 22 - and one 18-month-old grandchild.

Sekela yesterday thanked Epling's physician in Pikeville, Dr. Daniel Stamper, and officials at the Pikeville Methodist Hospital for providing Epling with a beeper so he could be easily notified when a donor heart was found.

Stamper said Epling worked as a coal miner until he had a massive heart attack in 1988. He said Epling has not been able to work since then. Epling had suffered from cardiomyopathy, a disease affecting the middle layer of cells in the heart's wall.

"He's a real fine, personable pleasant and outgoing person," Stamper said. "He has a real good personality and everybody truly loves him."

So far, there have been no signs of early rejection or infection, Sekela said. Epling will undergo his first biopsy to determine the strength of the transplanted heart on Wednesday. Doctors will then start him on physical therapy - walking on a treadmill and around the hospital.

"There are really no signs of anything bad going on," Sekela said. "I'm pleased but not surprised. I thought we'd keep him down there (in intensive care) for about five days, but by day two he was up out of bed and walking around his room."

"He really can't believe he's doing as well as he is right now."

Staff write Mike Mayhan contributed to this article.

UK Transplant patient leaves hospital with new heart, hope

Written by Bobby King
Story and Photo Source: Lexington Herald-Leader
Date: April 1991

Jimmy Epling

Jimmy Epling walked out of the hospital yesterday, politely opened the car door for his wife and climbed in behind her. As the car pulled away, he smiled, waved at a crowd that had gathered to send him off and began the first day of the rest of his life.

Only 18 days earlier, Epling a 40-year-old coal miner from Pikeville, received a new heart at the University of Kentucky's Chandler Medical Center.

The heart transplant was the first at UK.

"Well, I'm excited to get out of here, to tell you the truth," Epling said. "I'd like to get out and get me something good to eat for a change."

When he entered the hospital almost three weeks ago, Epling had to fight to get air into his lungs just so he could walk.

Yesterday, he spoke of playing basketball with his children again.

Epling will spend the next couple of months living in a Lexington apartment so he can be close to the hospital. Doctors will maintain a watchful eye on him to make sure his body doesn't begin to reject his new heart.

But Epling was confident that he would have no problems.

"Right now the infection is about all I'm really worried about," he said. "I'm not really afraid of anything. I believe I'm going to be alright."

He paused for a second and then said, "I know I'm going to be alright."

A Matter of the Heart

Jimmy EplingWritten by Barbara Greider
Source: Kentucky Alumnus Magazine
Date: Winter 1991

"I knew it was going to work and nobody was going to tell me different." This was the faith, confidence and determination of a 40-year-old Jimmy Epling, the first person ever to receive a heart transplant at the University of Kentucky Hospital. When he left his Pikeville home to make the 160-mile trip to Lexington, Epling told his apprehensive family, "Don't cry. I'll be coming back home with a new heart."

The patient's conviction was shared by a medical team who believed that finally a time was right for a history-making transplant at UK.

The program had faltered through a brief but tired history of raised hopes and unmet expectations when Dr. Michael E. Sekela returned to Kentucky to retrieve it.

Sekela seemed to be what Dr. Robert K. Salley, a new chief of cardiothoracic surgery, thought the program needed: a surgeon with world-class knowledge who could activate "all the fundamentals in place" so that UK could move rapidly toward transplantation. Sekela performed more than 100 heart transplants at Baylor/Methodist Hospital in Houston and had co-directed Baylor's multi-organ transplant program.

The 36-year-old surgeon possessed the nationally established reputation Salley had hoped the UK program would attract. Having completed a fellowship in cardiovascular and thoracic surgery at the UK Chandler Medical Center in 1988, Sekela was familiar with some of the reasons why plans for UK's transplant program had not progressed smoothly.

Undaunted, he returned to Kentucky in February 1991 to direct the program. When a donor heart for Epling became available, Sekela flew to a hospital in Kentucky to retrieve it while Epling was being brought to Lexington and prepared for transplant. On March 28, 1991, Sekela gave Epling his new hear. It was a four-hour operation, the first of its kind in Eastern and Central Kentucky.

With the surgery, UK became one of the only four hospitals in Kentucky to have performed a heart transplant (the other three are in Louisville). A collective sigh of relief was soon replaced with a quite air of confidence. The transplant program was living up to the long-awaited expectations. In short order, second and third transplants were performed.

Sekela said the second operation on Ruth Roy, a housewife from Fawbush, "legitimized" the program at UK. Once again, Sekela was not fazed by the challenge, he welcomed it.

"Her case was not a 'quote unquote' good one; she was far from the ideal recipient some programs required. She had heart surgery here in 1987 while I was at UK, and we remembered each other," he said.

With characteristic confidence, Sekela is directing a program that resists formalizing donor and recipient criteria in order to keep its options open and help patients like Roy. Sekela's goal is for UK to become known as a center that takes on complex cardiac problems.

"If we wanted to have close to 100 percent operative survival, we could achieve that by taking on only recipients who are not very sick and carefully screening donors and recipients," he said.

"What we've tried to do is to adjust the donor criteria to fit the acuity of the recipient. It is taking very calculated risks. I am willing to accept some morality up front if I think in the long run we can help some people who definitely would not have lived without taking a risk."

By late September, 13 heart transplants and one lung transplant had been performed. "We thought we'd be at number eight or nine by now," said Sekela. "You could say we are slightly ahead of schedule and relatively pleased." Sekela said he was "cautiously optimistic" that the UK program could perform 20 to 25 transplants a year with the addition of another patient coordinator.

"I don't ever want the program to get so big that the individual patient gets lost. That's why I left Baylor. The program here is exciting to me because of our level of involvement with the patient and the patient's family," he said.

Sekela works with the patient's own cardiologist (in Epling's case, Dr. Martin Berk, director of UK's Heart Failure Clinic), and with Dr. Salley, who prepares patients for transplant. Sekela credits a great team effort - doctors, nurses, and other health professionals - with the new program's success. He is particularly enthused about the work of Connie Taylor, a registered nurse with nine years of experience in the cardiothoracic intensive care unit who is UK's hart-lung transplant coordinator, and Joni Johnson, a social worker whose full-time position is dedicated to making certain that transplant patients have adequate funding.

Sekela said that UK will not turn away potential transplant patients for lack of funds. A transplant operation can cost from $80,000 to $100,000. The problems is not so much the cost of the procedure, which Sekela and the UK Hospital are willing to perform gratis when a patient's insurance will not cover the expense, but the reluctance of insurance companies to underwrite expensive medications which transplant patients must take for the rest of their lives.

Johnson's job is to seek the support of corporate foundations which have established programs to provide some patients with medication at no charge. Sekela said that now that UK's transplant program is established, it is time to focus on formalizing support.

Participants in the UK transplant program are referred either through outside physicians or through UK's Heart Failure Clinic, which may recommend patients for transplants if they are not good candidates for treatment with research medicines.

Potential transplant patients are listed with KODA (Kentucky Organ Donor Affiliates), a member of the United Network for Organ Sharing (UNOS) which operates a computer registry to match donor organs with waiting recipients. KODA is a federally funded program that serves the transplant needs of Kentucky, Southern Indiana and West Virginia.

By federal and state law, physicians and hospital staffs are required to offer families of brain dead patients the option of organ and tissue donation. KODA's "Sign and Tell" campaign encourages people to sign a donor card while they are alive and well, and inform family members of their pledge.

As heart-lung transplant coordinator, it is Taylor's job to coordinate the flurry of activity that takes place at the UK Hospital when it becomes known that a donor organ is available for transplant.

Taylor arranges the arrival and departure times of the surgical transplant team, and schedules time in an operating room. The donor is kept on life support until Sekela, who likes to make a personal evaluation of a donor heart on site, arrives. The other organs must be surgically removed before the heart is, because once the heart is taken out, everything else is going to die.

When a heart is removed, it is injected with a drug to stop it from beating and immediately placed in an ice chest. Then Sekela flies back with the heart to UK Hospital to perform the transplant.

When the program expands to 20 to 25 transplants a year, it will be possible to establish a data base for studies and provide basis for Sekela to continue a personal interest in circulatory mechanical support (also known as heart pumps).

"I brought a lot of useful experience with the.....heart pump from Houston. In order to apply that here, we would need to be doing 20 to 25 transplants a year. If we're at that size we'll get recipients who are sick enough not to be able to wait for a donor heart and who will need to have mechanical support implanted," Sekela said.

And what is life like after a transplant? Following surgery, attention is centered on keeping a patient's body from rejecting its new organ. The first month after a transplantation is especially critical.

To check for signs of rejection, heart biopsies are scheduled at regular intervals. The biopsies are procedures in which four or five pieces of heart tissues are obtained from a patient and then examined under a microscope by a pathologist. Backing up the biopsies are echocardiograms.

The development of cyclosporine, in combination with other immunosuppressant drugs, was a break through. Without an effective way to prevent rejection of a transplanted organ, large-scale use of the surgery first pioneered by Dr. Christian Barnard in South Africa had not been possible.

The medication, however, presents a dilemma. With natural immune systems quieted to prevent rejection, transplant patients are susceptible to opportunistic infections ranging from the common cold to the most esoteric diseases. In addition, some immunosuppressant drugs can cause serious side effects. For example, cyclosporine can adversely affect a patient's kidneys.

So, managing a patient's immunotherapy becomes very important. The goal is to slowly taper the dose to a level that maintains the transplanted organ but does not compromise the patient's health - adjusting as well as monitoring for sensitivity. Taylor helps patients become knowledgeable participants in their own immunotherapy.

Along with a daily routine of medication, other changes take place in a patient's lifestyle. In Epling's case, there are heart biopsies every two months for which he must travel to UK and blood work once a month (to monitor the effects of the cyclosporine) which he gets done at Methodist Hospital of Kentucky in Pikeville. Epling said the biopsies bother him more than the transplant surgery did, and that they prednisone (which is a steroid) has given him a puffy face. But these consequences are fine with Epling, who calls his transplant, "the greatest thing that ever happened to me."

"I couldn't have done on the way things were," he said. "I had to fight for air and couldn't even get to my own front porch. When Dr. Sekela explained to me what my chances were, I said 'Let's go for it.' I wasn't going to last without the operation and I wanted to see my kids grow up."

Sekela said he emphasizes to potential transplant patients that life expectancy after a transplant is not the same as that of the rest of the population.

"We've got the technique and the technology to the point where we can really do folks a lot of good but we're not giving them a normal life. I tell patients prior to accepting them for transplantation that we expect one-year survival to be 90 to 93 percent and five-year survival to be 70-75 percent. We're really not curing them, but to someone with no other chance, it's a wonderful thing."

Sekela said he would like to begin transplants in children and infants at UK early in 1992.

"I've been waiting for the adult program to get off the ground," he said. A general reason why most programs involve adults more often than children is that the pool of donor organs for children is much smaller than that for adults.

Sekela said he is particularly pleased that several of the hearts transplanted thus far were from Eastern Kentucky.

"We feel fortunate that this program is for all Kentuckians," he said. Originally cautioned not to expect people from Eastern Kentucky to donate organs, Sekela is pleased with the turn of events and attributes acceptance of the idea with the positive press and publicity the UK program received.

"Hearing success stories and finding our that the people being treated are ordinary people, not celebrities or VIPs, helps tremendously," he said.

Back in Pikeville, Epling is enjoying spending time with his family and has spent a lot of time fishing. Because of his lowered immunity, he has been advised to avoid crowds as a preventative measure. But his strength is returning, even to the point where he was able to swim to shore with his son after their boat got swamped, a story Sekela relishes telling. Epling has talked to some potential transplant patients to help allay their fears.

"I tell them the operation is not that bad," he said. "And I tell people they should be donors. All of my children carry donor cards."

Jennie Miller, KODA education coordinator, said "I like to think that people would be happy to pledge their body organs if they realized that long after they had died, someone else could be living a rich, full life. A story like Jimmy Epling's brings home the point. People can identify with a 40-year-old man who wants to keep on living."

Epling couldn't agree more. He continues to have a determination that his life will go on and get better with this new heart and faith that others will benefit from the transplant program at UK.

"I do not know how to put it into word," he said. "But if any of my children were to die, as horrible as that would be, I would want them to help someone else. Look at me. Some person I did not know has given me five and a half months of how a man should live."