Clinician-to-Clinician Update Clinician-to-Clinician Update

“Breathing Lung” Technology Keeps Donor Lungs Healthier Prior to Transplant

January 2015 - Transplant Services

Severe idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, occurring primarily in older adults and limited to the lungs. There is no cure for IPF, and treatment options are limited.1 Lung transplantation is so far the only treatment with proven benefit.

Patient

A 52-year-old male with severe IPF (Figure 1) and recurrent episodes of dyspnea was referred to Transplant Services and was placed on the transplant wait list. As part of a clinical trial, donor lungs became available that did not initially meet traditional transplant criteria. The lungs were from a donor who had experienced cardiac death before organ removal, and thus they had been in a state of warm ischemia.

Lung-Xray-pre-443x308
— Figure 1 - A 52-year-old male with severe IPF, pretransplant
Lung-Xray-post-443x299
— Figure 2 - 52-year-old male post-transplant. The donor lungs were initially considered unsuitable for transplant by traditional criteria before conditioning in the Organ Care System Lung.

Treatment

The donor lungs were placed into the Organ Care System Lung device at the donor hospital. The lungs remained in the device during transport back to University of Minnesota Medical Center with Transplant Services team members continuously monitoring their condition. Further monitoring was performed upon arrival so that the lungs could be evaluated against a rigorous 15-point status checklist. The lungs were found to be ideal for transplant. After giving consent, the patient underwent transplantation. The patient had no unexpected postoperative complications or graft failure and continues to do well (Figure 2).

Discussion

Lung transplantation improves outcomes for patients with IPF. According to the latest available data on 9,673 IPF patients transplanted from 1990 to 2012, as reported to the International Society for Heart and Lung Transplantation, the median survival was 4.7 years post-transplant. 2 This is contrasted with a median survival time of 2 to 3 years from the time of diagnosis for nontransplanted patients. Early evidence supports the use of lungs reconditioned using the Organ Care System Lung for IPL and for other lung transplant patients, suggesting the device provides better results than does transportation on ice.3, 4

References

1. Raghu G, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788-824.

2. The International Society for Heart and Lung Transplantation. 2014 Adult lung transplantation statistics. https://www.ishlt.org/registries/slides.asp?slides=heartLungRegistry

3. Mohite P, et al. Utilization of the Organ Care System Lung for the assessment of lungs from a donor after cardiac death (DCD) before bilateral transplantation. Perfusion. 2014 Oct 20. pii: 0267659114557186

4. Warnecke G, et al. Normothermic perfusion of donor lungs for preservation and assessment with the Organ Care System Lung before bilateral transplantation: a pilot study of 12 patients. Lancet. 2012;380:1851-1858.

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