New Transplant Technique Breathes Life Into Lungs
New approach could increase number of lungs acceptable for transplants.
Dec. 14, 2011— -- Nancy Block, 60, of Westchester, N.Y., was physically fit and had no history of medical problems, but a routine checkup that involved a quick listen to her chest detected something she recalled her internist saying, "didn't sound right."
Block felt a little short of breath and exhausted on some days, but nothing to make her think anything was out of the ordinary.
But Block was diagnosed in 2007 with a rare lung disorder called diffuse interstitial lung disease. After her diagnosis, her health started quickly deteriorating.
"When I was told that the only thing to save me was a lung transplant, I said, 'I'm not doing that,'" Block said, recalling that her illness crept up so suddenly. "It seemed so outrageous."
After seven unsuccessful attempts to undergo a routine double-lung transplant, Block became in October the second patient so far at New York-Presbyterian Hospital to successfully undergo a revolutionary experimental approach to lung transplantation that could offer more viable lungs to more patients like Block who are on the recipient wait list.
The technique, called "ex vivo" -- or, outside the body -- involves taking the lungs that were removed from the donor and placing them in a transparent case, where they are hooked up to a pump and ventilator. The lungs are closely monitored for up to four hours as they are nourished with nutrients and antibiotics and pumped with oxygen.
In the traditional lung-transplant approach, the lungs are assessed in the deceased donor's body before being removed. If the lung is considered viable, it is stored in cold temperatures within a short window of time before the transplant.
But the new preservation technique "revives" the lungs in a transparent box by gradually warming the lungs to normal body temperature, and the organ is reinstated in an environment as if it is in the body. The lungs are assessed and reconditioned in the operating room until the final minute before being placed in the recipient's body.
"It allows us to get a better judgment of the organ," said Block's surgeon, Dr. Frank D'Ovidio, associate surgical director of the lung transplant program at New York-Presbyterian/Columbia University Medical Center.
Nearly 30 percent of donor lungs are unsuitable for transplantation. But is some cases, otherwise viable lungs might be deemed inappropriate for transplant because the tests might not be accurate, D'Ovidio said.
In 2011, nearly 1,400 lung transplants were performed, according to the Organ Procurement and Transplantation Network, part of the U.S. Department of Health and Human Services.
"We have the potential to increase, even double, the number of transplants we're performing, and to satisfy the needs for more lung transplants," D'Ovidio said.
Bloch is one of 25 patients enrolled in a three-year FDA clinical trial involving five medical centers across the nation. The trial is designed to compare the ex vivo approach to the traditional method, and will be reviewed by the FDA to assess whether the technique is safe and should be cleared for standard use.
"We used lungs we would've not been able to do otherwise," D'Ovidio said. "Initial tests proved concerns, but instead, we tested over time ex vivo and we saw improvement in the lung."
The medical risks of the ex vivo transplants are relatively the same as the traditional transplant, and the recovery time is the same. Ideally, any patient who needs a lung transplant for any reason could potentially qualify for the procedure.
"This will be become an opportunity to match the needs of very sick group of patients," D'Ovidio said.
Bloch's bronchoscopy showed no signs of rejection.
"I believe it's because I got clean lungs," Block said. "When people ask me what they should do to help, I say they should be organ donors."
Less than four months after her transplant, Block is still in the throes of recovery. The transplant has forced her to forever give up one of her favorite hobbies, gardening, because of the potential bacterial dangers it poses to her vulnerable lungs.
While "not being able to garden is a crime," Block says, she's growing to believe the sacrifice is worth her new lungs.
"Sometimes, I feel trapped," she said, "but I know that feeling lessens over time."
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