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Perfusion process might improve success rate in lung transplants
Los Angeles Times
For decades, heart and lung transplant surgeons have followed a strict directive: Get the donor organ into the recipient as soon as possible.
That practice may be changing. In a study published Wednesday in the New England Journal of Medicine, researchers said both the number of donor lungs and successful transplants may be dramatically increased by treating the organs on a perfusion machine for several hours before transplantation.
The technique marks a paradigm shift in the transplantation field, experts said. About 85% of lungs made available for donation are not used because of tissue damage that potentially could be repaired with perfusion or other techniques.
“We won’t just transplant an organ,” said Dr. Shaf Keshavjee, senior author of the study and director of the Toronto Lung Transplant Program at Toronto General Hospital. “We will diagnose it, fix it, make it OK and then transplant it.”
The new technique pumps a liquid consisting of oxygen, proteins and nutrients into the donor lungs after they’ve been removed and transported to the recipient’s hospital. Keshavjee and his team used the Toronto XVIVO Lung Perfusion System, which was designed for this purpose. The system is being used around the world but is not yet approved by the Food and Drug Administration for use in the U.S.
Variations on the pre-transplant treatment concept are also being tried on kidneys, livers and hearts. Lungs, however, provide a unique opportunity because they are greatly needed and appear so amenable to perfusion treatment, said John Dark, a professor of cardiothoracic surgery at Newcastle University in England and president of the International Society for Heart and Lung Transplantation.
“This is the most exciting advance in lung transplantation since we first started 25 years ago,” said Dark, who was not involved in the study. “It’s converting lungs you can’t use into lungs you can use. At the moment, we are only using about 20% worldwide of the lungs that are offered to us.”
