Two Fascinating Pilot Studies

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.