New technology that keeps a donor’s lungs “breathing” before transplant surgery is leading to significant improvements in lung transplantation.
In 2013, Cardiovascular and Thoracic Surgeon Gabriel Loor, MD, became the first surgeon in the Midwest to perform a breathing lung transplant procedure—and the first in the world to enroll a patient into the international EXPAND clinical trial, which is evaluating the effectiveness of the new procedure.
We asked Loor a few questions about the revolutionary “breathing lung” technology, what it means for patients who need a lung transplant and how soon it could possibly become a common medical practice.
When the lungs are removed from the donor, surgeons typically place the organs into a very cold solution. They are then transported to the recipient’s hospital in an insulated container in order to preserve their function. This is the most common transport method used in the world right now. But there is a problem: Any organ outside a human body is in an unnatural environment. If you chill the organ, you protect it by slowing cell metabolism—reducing the amount of oxygen the cells of the lungs need to survive. Still, it’s only a matter of time before the quality of the lungs begins to deteriorate. Unfortunately, this can ultimately affect the health of the recipient and the outcome of the transplant.
During a breathing lung transplant procedure, the donor lungs are connected to a small machine that recreates the conditions of the human body. The device is equipped with a pump that mimics the heart, a miniature ventilator that replicates the body’s breathing action and an outflow that imitates the flow of blood away from the lungs. So the lungs are kept warm, blood continues to flow through them and they’re kept artificially breathing. By doing that, we essentially extend the time limit imposed on organ transportation and can monitor the health of the organ as we go. This means we can transport organs farther, which is important for patients in difficult-to-reach locations. The technology also gives us an additional insight into the lung’s health and performance during transport.
Currently, only roughly 20 percent of lungs available for transplant are used nationally, which means 80 percent are discarded. A lot of donor lungs are turned down because the health of the organ isn’t strong enough for transportation. The breathing lung technology allows us to use lungs that we couldn’t have transported before. Once we put the lungs on the device, we can observe them. Some that weren’t perfect in the beginning may actually improve while transported on the device. Increasing the number of available organs is critically important because almost a third of patients on waitlists will die waiting for an offer.
That is the primary question the ongoing EXPAND clinical trial is trying to answer. The objective of the trial is to measure lung function within the first three days after a breathing lung transplant. The findings are currently being reviewed by the FDA. So far, results presented in the International Society of Heart & Lung Transplantation showed a 50 percent reduction in the incidence of graft failure, which occurs when the recipient’s body rejects the new lungs.
At the time, it was very, very new. After our breathing transplant was complete, we were shocked. The patient’s new lungs performed as if they had never traveled or been transplanted—as if they were the person’s very own organs. Since then, we’ve gained and accumulated a considerable amount of experience with the new technology. The University of Minnesota is the world’s highest enroller in one of the leading clinical trials right now, and we’ve had the greatest success with it. Now, we’re waiting for FDA approval, which could come as early as next year. Once it is approved, we hope to be the first center in the nation to use this as a standard of care and we’ll be able to dramatically change the lives of our patients.