New technique to repair lungs outside the body may double transplants worldwide

Dr. Shaf Keshavjee (above), the surgeon that performed my lung transplant in 2002, is a world leader in lung transplantation and lung transplant research. His body of work is having a global impact and this article exemplifies that. The XVIVO Lung Perfusion Technique has the potential to double the number of lungs available for transplant, not only in Toronto, Canada but worldwide as other centers adopt the technique.

Canadian Institutes of Health Research (CHIR)

Research Profile July 2009

In a room at the Toronto General Hospital (TGH), a pair of human lungs is breathing inside a glass dome. As they breathe in and out, fed by a supply of gases and nutrients, the lungs are healing themselves from injury. This revolutionary technology promises to improve the fate of many patients waiting for lung transplants in Canada.

In Canada, nearly 300 patients with lung disease died between 1997 and 2006. These patients died because of a shortage of suitable lungs available for transplant. In fact, as few as one in 10 donated lungs available can be used. The new technology at TGH may allow doctors to more than double the number of lung transplants done worldwide, according to Dr. Shaf Keshavjee of TGH's Division of Thoracic Surgery.

"Lungs are very fragile as organs," says Dr. Keshavjee, who directs the Toronto Lung Transplant Program. "This new system allows you to assess the lungs, to diagnose what's wrong with them, and then repair them."

Dr. Keshavjee's team worked for years studying lung transplant and repair experiments on animal models. In December 2008 they announced a successful first use of the system in transplanting a pair of lungs into a patient. They have since completed twelve other successful transplants with the system, called The Toronto XVIVO System.

The work is being funded by the Canadian Institutes of Health Research's CIHR/Rx&D Collaborative Research Program, a partnership of CIHR and Canada's Research-Based Pharmaceutical Companies. Other collaborative partners include Astellas Canada, Wyeth Pharmaceuticals and Vitrolife Inc.

The Toronto XVIVO Lung Perfusion System was developed by Dr. Keshavjee's team and Virolife Inc., which specializes in lung preservation. The technique allows lungs to be kept at body temperature, outside the body. Fed with a bloodless solution containing nutrients, proteins and other medications, the organs exchange oxygen and carbon dioxide through a ventilator and can repair themselves while the researchers facilitate the recovery and check them. The lungs can be kept inside the device for up to 18 hours, though 12 hours is the current routine limit. A similar blood perfusion system developed in Sweden for short term assessment only works for about an hour before the lung becomes damaged.

"We've already successfully transplanted twelve* patients now using the XVIVO System, so those patients received lungs that couldn't have been used before," says Dr. Keshavjee. "They've all done superbly, every single one of them. We're now able to use lungs that we couldn't use before."

*As of today, Dr. Keshavjee tells me that 14 patients have now been transplanted - Merv.

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency responsible for funding health research in Canada.

NOTE: Also read the article at physorg.com.

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