Ex Vivo proceedure breaths new life into lung transplants

We breathe 17,000 times a day, but for more than 1,600 people waiting for a lung transplant, each breath is a struggle.

Now, there's new hope for patients waiting to inhale easier.

Nancy Block travels far and wide to find the perfect paintings. But a few years ago her world was closing in on her. She was diagnosed with a rare lung disease, fibroelastosis.

"I started on oxygen, two liters,” said Block. “By the time I was in the hospital, I was on 8, which is an inhuman amount."

The tissues of her lungs were stiffening. Soon they would stop working. A transplant was her only option. Nancy was called in for a transplant seven times, but each time, the organ was either not a perfect match or was not working properly. But doctors at New York Presbyterian offered her a new option.

"The Ex-Vivo is an opportunity to test lungs we would be turning down otherwise," said Frank D’Ovidio, Director of the Ex Vivo Lung Perfusion Program at New York Presbyterian-Columbia.

In Ex Vivo, lungs that would not pass the test for transplant are hooked up to a perfusion and ventilator system outside the body.

"Over four hours we can have a more thorough understanding of how that lung is really ventilating and performing," said D’Ovidio

The lungs are re-warmed, fluid is forced through them and a special solution re-nourishes them. So far, seven lungs have been tested, four were turned down, but three were successfully transplanted. Nancy has one of them.

"I was breathing right away without oxygen,” she said. “I'm walking, I'm driving."

And she's looking forward to flying to Europe to find her next work of art.

Because the lungs are perfused, doctors believe they will recondition and make a better organ for transplant with lower risk of failure.

Right now there is discussion about the possibility of Ex Vivo becoming the standard procedure for all lung transplants.

BACKGROUND: There are more than 1,600 people waiting for a lung transplant today. The wait for suitable donor organs to become available may be a year or longer. The average waiting time on the list is 18 months. Unfortunately, many patients who would benefit from a lung transplant sadly die before suitable donor lungs become available. The shortage of organ donors is made even more dramatic for those waiting for lung transplant as donor lungs are particularly delicate and are easily damaged by events that happen before their removal from the donor. This means that only 1 in 5 of the potential donor lungs available, currently used in lung transplants. (Source: http://www.hta.ac.uk/project/2554.asp)
THE TRANSPLANT: There are four main types of lung transplants. The first three depend on finding the right donor who has just died but has a healthy lung. The fourth type depends upon finding two healthy living donors. Your doctors will determine which type of lung transplant is best for you and your condition.

Single lung transplantation: Although you have two lungs, certain patients can live a normal, healthy, and active life with just one good lung. When a single lung transplant is done, one of your bad lungs is removed and a new healthy lung is put in its place.

Double lung transplantation: This operation involves taking both lungs out and replacing them with new lungs. Both lungs are replaced at the same time with two good lungs usually coming from the same organ donor.

Heart-lung transplantation: This operation involves taking out the heart and both lungs at the same time and putting in a new heart and two new lungs-all from the same donor. This is the rarest form of lung transplantation.

Living donor lobar transplantation: In this operation, two healthy living donors each give you one lobe (out of five normally present). Typically, both of your lungs are taken out and replaced with a right lower lobe from one donor, and a left lower lobe from the other donor. This operation is usually done on patients who are either in rapid decline, or are so ill that they will not be able to get through a successful transplant from a deceased donor. (Source: American Society of Transplantation)

NEW TECHNOLOGY: A new technology attempts to make the transplant process easier and to make sure the lungs are in good condition before transplant. The "ex vivo" or outside-the-body approach involved removing lungs from a deceased donor, then enclosing them inside a transparent dome and connecting them to a cardiopulmonary pump and a ventilator. For four hours, the lungs were infused with nutrients and antibiotics. They were gradually warmed to body temperature, ventilated and oxygenated - a process that resembles breathing, with the lungs inflating and deflating. Once determined to be viable, the lungs were immediately transplanted into the patients. Currently, fewer than 30 percent of donor lungs are acceptable for transplantation, but physicians say ex vivo has the potential to double this figure as the reconditioning process is refined and improved.
The recent transplants at NewYork-Presbyterian/Columbia are part of an ongoing FDA investigational multicenter clinical research trial designed to compare outcomes from lung transplants using the ex vivo technique with those using the traditional method. This investigational trial, currently taking place in the United States, is coordinated and funded by Vitrolife, makers of the ex vivo perfusion system. (Source: New York Presbyterian/Columbia)


Jaya Tiwari
New York Presbyterian/Columbia
(212) 342- 1518

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