A doctor writes: Procedure will increase size of donor pool and cut waiting times

Mater hospital team breaks new ground with innovative surgical process

 Leigh Bagnell, a patient with cystic fibrosis who received Ireland’s first ex-vivo lung perfusion transplantation at the Mater hospital. Photograph: Gareth Chaney/Collins

Leigh Bagnell, a patient with cystic fibrosis who received Ireland’s first ex-vivo lung perfusion transplantation at the Mater hospital. Photograph: Gareth Chaney/Collins

 

The successful completion of a new type of lung transplant in Ireland is good news for patients.

Karen Redmond, consultant thoracic and lung transplant surgeon and her team at the Mater Misericordiae University Hospital in Dublin have broken new ground by carrying out the State’s first ex-vivo lung perfusion transplantation (EVLP).

Until now more than 80 per cent of donor lungs could not be transplanted into recipients. This has meant lengthy wait times for those waiting for a transplant, with about a fifth of patients dying while on a waiting list.

Lung transplantation is the only life-saving treatment for patients with certain types of end-stage lung disease such as cystic fibrosis and idiopathic pulmonary fibrosis. Where possible, both donor lungs are given to the patient.

Donated organs

More than many other donated organs, lungs are assessed as unsuitable for transplant because of the damage they experience as part of the donor’s last illness.

Pneumonia acquired while the person was on a ventilator, excess fluid in the lungs (pulmonary oedema) and tissue damage from pressure on the airways are some of the reasons why donor lungs cannot be used.

At a microscopic level, the presence of the donor’s white blood cells in a transplanted lung increases the likelihood of the organ being rejected by the recipient’s immune system.

Donated lungs

EVLP helps solve some of these issues, thereby increasing the suitability of the organ for transplant. The process keeps the lungs alive, breathing outside the body while supported by nutrients; donated lungs are placed inside a sterile plastic dome attached to a ventilator, pump, and filters for a period of three to four hours.

The lungs are gradually rewarmed and brought back to normal body temperature while being treated with a bloodless solution that contains nutrients, proteins, and oxygen. This can reverse lung injury and remove excess lung water. It also removes the donor white cells that increase the possibility of organ rejection.

During the process, lung function is evaluated continuously by the transplant team before a decision is made whether the organ is suitable.

When introduced at the Medical University of Vienna, EVLP resulted in a 28 per cent increase in lung transplants in one year.

Researchers reported low rates of organ rejection and a five-year survival after transplantation of 70 per cent.

The Mater team are predicting that for every two organ donors currently deemed unsuitable for lung transplant, using EVLP can restore the lungs of one. This will significantly increase the effective size of the current donor pool.

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