A breath of fresh air

> A new pro­ce­dure could keep donor lungs out­side the hu­man body for over 12 hours with­out af­fect­ing the pa­tient’s chances of sur­vival

The Sun (Malaysia) - - ZEST -

ANEW tech­nique could nearly dou­ble the pre­cious few hours sur­geons have to carry out lung trans­plants, rais­ing hopes for sav­ing more lives, said a re­cent study.

Doc­tors typ­i­cally rush to com­plete a trans­plant within about six hours of the lungs be­ing taken from a donor, with time be­ing of the essence be­cause the tis­sue starts to break down af­ter that.

But the new method, which uses a process called ex-vivo lung per­fu­sion (EVLP), could help keep lungs out­side the hu­man body for over 12 hours with­out sig­nif­i­cantly harm­ing their even­tual re­cip­i­ent’s chances of sur­vival ( right, above).

The ex­tra time means more trans­plants could be per­formed be­cause or­gans which were pre­vi­ously too far away could now reach re­cip­i­ents in time, said the study pub­lished in The Lancet Res­pi­ra­tory Medicine jour­nal.

Get­ting the or­gans to re­cip­i­ents is the dif­fer­ence be­tween life and death for peo­ple on wait lists, and who num­ber about 1,700 in the US and Canada alone.

The process starts with the lungs be­ing taken from a donor, and then put on ice im­me­di­ately. Af­ter be­ing moved to the hospi­tal where they are needed, the or­gans un­dergo EVLP.

This con­sists of warm­ing the lungs and con­tin­u­ously pump­ing a liq­uid full of oxy­gen, nu­tri­ents and pro­teins through them, at which point the “par­a­digm shifts from slow­ing death to pre­serv­ing life”, the study says.

If the lungs are sim­ply cooled, stan­dard prac­tice calls for the trans­plant to hap­pen within six to eight hours of be­ing out­side the donor’s body.

But with EVLP, which takes at least four hours, the dead­line can be pushed out to over 12 hours.

“At a time when there is a crit­i­cal short­age of lungs avail­able ... com­bin­ing cold preser­va­tion and EVLP will hope­fully make a lot more donor lungs avail­able for suc­cess­ful trans­plan­ta­tion,” wrote lead au­thor Marcelo Cypel, a sur­geon at Toronto Gen­eral Hospi­tal.

The study fo­cused on 906 adults who got lung trans­plants at Toronto Gen­eral from 2006 to 2015, com­par­ing those whose or­gans did and did not un­dergo EVLP.

The au­thors found peo­ple who got or­gans given EVLP and kept out­side the hu­man body for more than 12 hours spent a sim­i­lar amount of time in the hospi­tal as those who did not.

Also, both groups of pa­tients had sim­i­lar lev­els of lifethreat­en­ing com­pli­ca­tions and sur­vival rates one year af­ter surgery.

How­ever, it should be noted that while the re­searchers said the re­sults sug­gest EVLP pro­vides “ad­di­tional ben­e­fit” over just ic­ing down the or­gans, the “max­i­mum safe preser­va­tion time for hu­man lung trans­plan­ta­tion re­mains un­known”. – AFP

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