The lung out of the dome
(Vienna, 22 April 2010) A spectacular new procedure to improve donor lungs before transplantation has been applied for the first time in Austria in the Division of Thoracic Surgery at MedUni Vienna. In the so-called "ex-vivo perfusion" process the lung is connected to a tube system similar to a heart-lung machine and to a ventilator and assessed under a plastic dome. During ex-vivo perfusion dramatic improvements in the function of the first three lungs tested in this way were achieved at the Vienna General Hospital AKH. All three lungs were successfully transplanted afterwards and the patients are doing well.
Ex-vivo lung perfusion was developed in its current form in Sweden in 2007 and it is only in Canada that it is already being used in greater numbers. This means Austria, under the supervision of Priv. Doz. Dr. Clemens Aigner, is one of the first countries in the world where this concept is being successfully applied.
The background to the development of ex-vivo lung perfusion is the lack of suitable donor organs for transplantation. Many more patients need a lung transplant than there are currently available donor lungs, so some patients die on the waiting list for an organ. We also repeatedly see cases where donor organs cannot be used for a transplant because there are doubts about whether they would function properly and it has not been possible to carry out a detailed evaluation so far. With the ex-vivo lung perfusion system the lung can now be precisely assessed and "repaired". Lungs which earlier would not have been used for transplantation demonstrate an impressive improvement of the organ function in this system and can subsequently be transplanted in an optimum condition. All transplants conducted with this system by Doz. Aigner ran smoothly and the recipients are doing well. Ex-vivo lung perfusion therefore means the number of available donor organs can be clearly increased.
The earlier principle of "cold" organ preservation to reduce cell metabolism and minimise the damage caused by the lack of oxygen and nutrients is being revolutionised by this new technique. The perfusion is carried out with a bloodless solution at body temperature. As has been common practice so far, the donor lung is initially taken into the operating theatre in a cooled state and is then connected to the perfusion according to a precise system and is heated for a period of 30 minutes. To prevent damage to the organ, ventilation is not started until the lung is heated to body temperature. During ex-vivo perfusion there is ongoing monitoring of the decisive parameters such as oxygen intake, the elasticity of the lung and the respiratory pressure and the organ function is therefore checked. The lung is provided with nutrients and oxygen by a special solution and the fluid balance is optimised.
In the future this will lead to countless possibilities for treating and optimising the lung before transplantation. Possibilities also include in particular immunological pretreatment of the donor organ to prevent rejections. The findings made here may also be of invaluable benefit for the treatment of patients with acute lung failure.
Headed by Univ. Prof. Dr. Walter Klepetko, Vienna, with around 100 transplants carried out per year, has for many years been one of the three biggest lung transplant centres in the world. Since January 2010 the lung transplantation programme has been located in the newly-established Division of Thoracic Surgery.
Biographical info: Priv. Doz. Dr. Clemens Aigner has been working at the Department of Surgery at the Medical University of Vienna since 2002. In 2008 he qualified as a professor focusing on "Advanced techniques in lung transplantation". He is currently working as a senior physician in the Division of Thoracic Surgery. His research concentrates on thoracic surgical oncology as well as lung transplantation. Stays abroad took him to the thoracic surgical divisions of Toronto General Hospital in Canada and U.Z. Gasthuisberg in Leuven, Belgium. Doz. Aigner was the first recipient of the Ernst Wolner Award in 2008. Other prizes he has received are the Wolfgang Denk Award and the ESTS/ACECP Fellowship, which was presented for the first time in 2009. As well as the publication of many scientific articles in specialist journals and book contributions Doz. Aigner is also a reviewer for renowned thoracic surgery journals and has given many lectures at the national and international level.