Those waiting for lung transplants have high hopes for new technology
I am very pleased to post this article as I have had the pleasure of following the clinical trials from the beginning. Dr. Shaf Keshavjee, who lead the development of the Toronto XVIVO Perfusion System is the surgeon who performed my lung transplant 11 years ago. You can read more here about this medical breakthrough that is having a global impact in saving lives.
The first successful transplants after ex vivo perfusion were done in Sweden in 2001, and the system under clinical trials in the U.S. was developed by a research group in Toronto in 2008. The Toronto group, said Love, has since done about 90 transplants of lungs that otherwise would have been thrown out. Lungs treated with the ex vivo technique now account for about 20% of their transplants, and the results are promising.
By of the Journal Sentinel, Milwaukee, Wisconsin
Told he had less than a year to live, Trey Schwab, then the assistant men's basketball coach at Marquette University, hung on for 26 months before the right set of lungs became available for transplant in 2004.
When his surgeon opened him up and saw his lungs, Schwab recalled, the doctor said he only would have lasted another few weeks.
For Patricia Nichols, the wait isn't over. Nichols, 53, of Milwaukee, has been on the transplant list for about a year, and is still waiting.
Now, a technology called ex vivo lung perfusion is nearing the end of clinical trials in the United States, and may shorten waits for transplanted lungs. This technology is on its way to Froedtert Hospital in Wauwatosa in the laboratory of surgeon Robert Love.
Wait times for lung transplants are long — in large part because only a small fraction of the lungs offered for donation are deemed good enough to give to a patient.
"Twenty percent," said Nichols. "That's so few."
Using the ex vivo technology, said Love, "I expect that would increase to 50%."
Love, chief of cardiac surgery at Froedtert, recently received an ex vivo perfusion system for research use. Froedtert hopes to use the technology clinically as soon as it is FDA-approved.
The process involves putting lungs that have been removed from a donor on a machine that ventilates them and circulates a blood replacement fluid called perfusate, Love said.
This helps surgeons use lungs that would otherwise be discarded, because they can check that the lungs function properly before transplanting them. They can monitor how well the lungs expand, and how well they transfer oxygen to the perfusate.
Surgeons also can treat the lungs before they're transplanted.
"It's a living, personalized medicine for the set of lungs," Love said.
Treating lungs on the ex vivo perfusion machine, he explained, can help doctors remove extra fluid from them. It also gives them a chance to treat the lungs with antibiotics, anti-inflammatories and antivirals before transplantation.
Nilto De Oliveira, an associate professor at the University of Wisconsin-Madison medical school and a surgeon, has done research on ex vivo perfusion and likened the ex vivo equipment to "a repair center for organs."
The first successful transplants after ex vivo perfusion were done in Sweden in 2001, and the system under clinical trials in the U.S. was developed by a research group in Toronto in 2008.
The Toronto group, said Love, has since done about 90 transplants of lungs that otherwise would have been thrown out. Lungs treated with the ex vivo technique now account for about 20% of their transplants, and the results are promising.
"Their results with these lungs are really the same as with the standard lung transplant," he said.
This increase in the number of lungs available could help shorten the wait times for transplants, and perhaps reduce the number of patients who die each year on the wait list.
"To me as a recipient, that's huge, and I know that it's huge to the thousands of people that are waiting," said Schwab.
Nichols said that if she were offered lungs rehabilitated with the ex vivo technique, she'd jump at the chance.
"If there was an opportunity," she said, "I would say yes for sure."
Love, who is on the FDA safety monitoring board for the U.S. clinical trial, is optimistic the ex vivo technology will be approved for wide use before long. But, he said, there's still work to be done, which is why his lab got an ex vivo system for research purposes.
Surgeons also are exploring the possibility of using gene therapy to help repair the lungs before transplant. In the future, said Love, treating lungs on the ex vivo system might help reduce the risk of chronic rejection, or make it possible to use lungs from patients who die at home rather than in the hospital.
De Oliveira said he thinks that using these treatments to reduce chronic rejection is a "huge jump," but is still optimistic about using ex vivo perfusion to improve donor lungs.
"I think the potential for the technique is endless," he said.
But technology is only part of the solution when it comes to finding enough lungs — and the right lungs — to meet the needs of those on the transplant waiting lists.
The rest comes down to getting people to register as donors, especially among minority groups. African-Americans comprise about 20% of transplant recipients, but only 15% of donors, though the numbers vary by organ.
"We have to get the word out about people signing up to be donors, especially African-Americans," said Nichols, who is African-American.
Milwaukee County has a particularly low donor registration rate, said Schwab, who is now the outreach coordinator at the UW Organ and Tissue Donation program and worked to develop Wisconsin's online donor registration system.
Nichols noted it only takes a few minutes to register. And for those on the fence, she suggested asking themselves, "What if this were somebody that I love that needed this?"
Because, she said, "it is somebody's loved one."