Big Ambitions After a Second Double Lung Transplant at Duke

By Larissa Biggers
January 05, 2021
Sara Kominsky smiles during a hike

Two weeks after her second double lung transplant, Sara Kominsky, who was born with cystic fibrosis, went hiking.

Finishing a 60-mile endurance march is a major accomplishment for anyone. It is particularly impressive for 49-year-old Sara Kominsky, who completed the event in a day and a half, just three months after her second double lung transplant at Duke.

A Full Life Despite CF

Kominsky was born with cystic fibrosis (CF), a genetic disease that can cause complications including extreme fatigue, chronic coughing, lung infections, and trouble breathing. Since she was a child, she faced difficulties common to people with CF -- including yearly hospitalizations and doses of antibiotics every winter -- but she described herself as “reasonably healthy” until she was in her early 40s. “At that point,” said Kominsky, “my lungs declined, and I couldn't do what I wanted to do.” As an athlete, fiction writer, avid traveler, and mother of two daughters, she had a long list of plans for the future. She consulted with her doctors and learned that her only option for achieving her goals was lung transplant surgery.

Preparing for Evaluation

To be approved for lung transplantation, candidates must be both strong enough to undergo surgery and committed to staying healthy afterward. To prepare for her evaluation, Kominsky began on what would be 18 months of pulmonary therapy near her home in Riner, VA. At the same time, she researched various lung transplant programs and put Duke at the top of her list because of the program’s success rates and short waitlist times.

Before she could be evaluated, Kominsky suffered a lung infection -- a potential barrier for other centers, but not for Duke, which has the experience and expertise to perform transplant surgery on people who might be turned away from other centers. Kominsky’s transplant coordinator, Kim Holleman, explained, “We look at everybody. We don't rule people out because of their age or other health conditions. We just look at them as a person and make sure that they're going to do well through the surgery and afterward because it's a lifelong commitment.”

After a thorough evaluation at Duke, Kominsky’s transplant evaluation team agreed that she was ready to make the commitment, and she was approved for surgery. Fifteen days after her name was added to the national database for donor organs, she underwent a double lung transplantation.

A Common but Serious Complication

The most common complication of lung transplant surgery is chronic rejection -- when a recipient's immune system continually attacks their donor lungs, despite all efforts to prevent and treat the condition. Holleman said that although Kominsky was a model patient -- vigilant about following every recommendation from her transplant team, including taking her medications, exercising, and eating a healthy diet -- her lungs succumbed to chronic rejection a year after surgery. Once again, she learned that she would need a lung transplant.

A Second Transplant

After completing the transplant evaluation process a second time, Kominsky continued her efforts to maintain her good health. “The second time, I knew what was expected of me, so I kept myself in really good shape because I know how critical that is.” To be closer to Duke, she and her husband relocated to Durham, and she took part in pulmonary rehabilitation at Duke in preparation for surgery. This time, she waited six weeks before she received the call that donor lungs had been matched to her.

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"After my first experience, I couldn't go anywhere else -- there was just no question the second time that I would go to Duke. They were amazing."

Sara Kominsky

Why Duke

Kominsky chose Duke not once, but twice for lung transplant because “the Duke statistics and success rates are obvious, but what’s also different is the caring from the transplant team. And it really starts from a phlebotomist saying something kind to start your day off right, down to the surgeon giving you a hug and just inspiring so much confidence.” She went into her second transplant surgery with no doubts. “That kind of confidence in your team is invaluable. And I think it's something that makes Duke incredibly special.”

Reaching Her Goals

After her second surgery, Kominsky rebounded quickly. Three months after her 60-mile endurance event, she completed a rucking marathon, in which runners wear a 20-pound pack during the 26.2-mile run. She has seen her older daughter start college, is back to writing fiction, and is making plans to travel with her husband. Her transplant coordinator is impressed by her progress and has high hopes for her future. “She runs marathons on the treadmill!” said Holleman. “Who does that?”

Sara Kominsky during a marathon
Sara Kominsky wore a 20-pound pack during a marathon, six months after a second double lung transplant.
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