American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Do what’s right for the organ

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday First Edition

Of every 100 potential donor lungs, only 20 will be transplanted into a recipient. And of these, an additional four to six recipients will suffer from severe immunological graft dysfunction. These are ratios that Dr. Shaf Keshavjee, MD, MSc, FACS, FRCSC, and this year’s John H. Gibbon Jr. lecturer, is dead set on changing.

Dr. Keshavjee and his colleagues’ goal is to triple the number of donor lungs that can be transplanted successfully by improving an organ’s viability. To achieve this, they are beginning to ask fundamental questions regarding the 80 percent of donated lungs that don’t meet current clinical criteria for transplantation.

“Can you repair an organ outside of the body before transplantation? Can you make the organ better than the way you found it? These are the types of questions we’re trying to answer,” says Dr. Keshavjee.

Slowly yet surely, his research is finding that the answer to these questions is yes. He has discovered that the most effective way to improve the odds of success in lung transplants is the use of ex vivo lung perfusion (EVLP), a procedure that minimizes swelling in donor lungs to make them more suitable for transplantation.

During EVLP, donor lungs are warmed to normal body temperature. Donor blood, inflammatory cells and other potentially harmful biologic factors are removed and the lungs are treated with antibiotic and anti-inflammatory agents.

“We’ve continued to show that lungs that undergo EVLP, which are lungs that would not have been used traditionally, perform equally to standard-criteria donor lungs in our program,” he said.

This technique has gone a long way toward increasing the number of donor lungs that can be successfully transplanted. At Dr. Keshavjee’s practice at the University of Toronto, the number of available donors has remained static, but he and his colleagues have steadily increased the number of transplants.

“About 30 to 40 percent of the lungs transplanted at our center undergo ex vivo perfusion,” he said.

According to Dr. Keshavjee, EVLP is not the end, but a means to an end. Just as medicine for patients has become increasingly personalized, he sees EVPL making this approach possible for donor organs. By combining EVPL with existing drugs, biological therapies and potentially even gene therapies, there is the potential to repair and preserve more organs for transplantation.

Additional Information:
The John H. Gibbon, Jr. Lecture: The Future of Transplantation: Personalized Medicine for the Organ, was held October 23 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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