One of the challenges with lung transplants is the low percentage of available lungs that are eventually transplanted. World-wide that percentage is only 15%. In Toronto it's higher but still below 35%. By contrast, that number for kidneys is 70%.
Toronto General Hospital is a world leader in trying to improve that percentage by both improving the preservation and preparation of suitable lungs prior to implant and by "recondtioning" lungs that don't meet all the standard criteria for acceptance.
A new technique using Ex Vivo (outside the body) Lung Perfusion is being tested in Toronto and all the patients on the list are being invited to participate in two studies.
The ex-vivo technique involves removing the lungs and ventilating them with a machine while perfusing them to cleanse them and help the lungs to repair damage naturally. This is all done at body temperature which is a big difference from current procedure. At the moment lungs once they are removed are preserved awaiting implantation in 4 degree solution. This shuts down cellular activity and prevents natural regeneraton and repair.
The first study of three patients involves bi-lateral transplants where one lung is preserved the usual way in 4 degree solution and the second is perfused at body temp for 2 to 4 hours before implantation. They will then see if there are any differences between the two lungs that shows perfusion improves acceptance and healing.
The second of 22 patients involves using lungs that don't meet current standards and perfusing them at room temp to see if they come up to standards. If they do they are used. If not they are discarded.
This opens up a potential whole new world of reconditioning body parts or a kind of "body shop".
The video we were shown was quite fascinating. The naked lungs sit in a glass or plastic bubble device looking all the world like a large turkey hooked up to a ventilation tube. They "breathe" as the perfiusion takes place and apparently 2 to 4 hours are required to demonstrate that the perfusion has worked or has failed to improve lung functioning.
TGH is a leader in this technology and we are all excited by the possibilities it opens up - better implantation results and a larger supply of potential lungs.
At the personal level it means that if I am accepted into one of the trials, it will improve my chances of getting a transplant earlier.
The first trial of 3 seems to me to be less risky than the larger trial. In the first trial they will be using fully acceptable lungs and just preserving them using two different techniques. In the larger trial they are using sub-par lungs that have been reconditioned and there is a chance that reconditioned lungs that look OK after perfusion still fail after implantation. So we have a decision to make after we review all the details and talk to the doctors.
Thursday, August 21, 2008
Thursday, August 14, 2008
A Two-Tank Party
It's been a hectic two weeks and I haven't entered anything here for some time. We have had first one sister arrive from England then my second sister with their respective husbands for overlapping holidays. Our 30th Wedding Anniversary celebration fell in the middle of all of this and we had what I'm calling a Two-Tank Party on August 4th arranged by my sisters and our daughters - 2 tanks because that's what it took in oxygen to get through the festivities.
We were joined by many friends and family - those who were in town for the long weekend and those who came back early - and it was great to see everyone. As a result of many fine gifts, I think I have figured out the empirical relationship between consumption of single malt scotch and oxygen saturation levels - one dram per 1.5 percentage points - I'll leave it to you to figure whether the effect is positive or negative.
Life goes back to somewhat normal tomorrow - back to a two/three person household instead of 8 - and then it's a short slide to Labour Day and cooler weather.
I'm in my 9th week and starting the third month on The List. During the last three weeks it has been a tremendous help to have my sisters and their husbands come to physio and help with set up, wipe down of the equipment etc. I can skate through the propgram in about two hours with assistance whereas it takes about an extra 30 minutes on my own. Stephanie and Anne-Marie will take over when my last sister leaves to go back to the U.K.
The novelty of physio has worn off a bit and I know it will seem more of a grind as the Fall appoaches. On the plus side I am feeling much fitter and I'm up to 1.8 miles an hour for 20 minutes on the treadmill and tension 5 - whatever that means - on the bike. I'm also using weights more for leg and hip exercises so the program is having a positive impact on my level of fitness and general well being.
I think the number of transplants being performed has increased after what seemed to be a quiet Spring. That always is good for a lot of water cooler speculation in the Treadmill Room and adds to the buzz and general feeling of anticipation in the air so we are all hopeful. A good way to shift from summer to fall mode.
We were joined by many friends and family - those who were in town for the long weekend and those who came back early - and it was great to see everyone. As a result of many fine gifts, I think I have figured out the empirical relationship between consumption of single malt scotch and oxygen saturation levels - one dram per 1.5 percentage points - I'll leave it to you to figure whether the effect is positive or negative.
Life goes back to somewhat normal tomorrow - back to a two/three person household instead of 8 - and then it's a short slide to Labour Day and cooler weather.
I'm in my 9th week and starting the third month on The List. During the last three weeks it has been a tremendous help to have my sisters and their husbands come to physio and help with set up, wipe down of the equipment etc. I can skate through the propgram in about two hours with assistance whereas it takes about an extra 30 minutes on my own. Stephanie and Anne-Marie will take over when my last sister leaves to go back to the U.K.
The novelty of physio has worn off a bit and I know it will seem more of a grind as the Fall appoaches. On the plus side I am feeling much fitter and I'm up to 1.8 miles an hour for 20 minutes on the treadmill and tension 5 - whatever that means - on the bike. I'm also using weights more for leg and hip exercises so the program is having a positive impact on my level of fitness and general well being.
I think the number of transplants being performed has increased after what seemed to be a quiet Spring. That always is good for a lot of water cooler speculation in the Treadmill Room and adds to the buzz and general feeling of anticipation in the air so we are all hopeful. A good way to shift from summer to fall mode.
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