Lung Transplantation Advances: ECMO and EVLP

Advanced Technologies Expand Options for Lung Transplant Recipients

Specialists within the Lung Center at Brigham and Women’s Hospital (BWH) are utilizing the latest technologies to improve the viability of donor lungs and the potential for transplantation for more patients.

“Typically, for every 10 donors, only one set of lungs is suitable for transplantation, making the lungs a highly valued organ,” said Raphael Bueno, MD, Chief of Thoracic Surgery at BWH, and co-director of the Lung Center. “To better serve our patients, we need to seek out as many potential donors as possible, which means patients on the waitlist can get lungs transplanted sooner, thus reducing the mortality rate.”

The Lung Center has increased the number of lung transplants performed annually by making new technologies available to patients, and increasing staffing to include four surgeons whose focus is to perform lung transplants, said Dr. Bueno.

“We also send a surgeon, perfusionist, and resident/fellow to donor hospitals to evaluate each offer, which has helped increase lung transplant volume this year. Additionally, we began evaluating ABO compatible donors for recipients, whereas in the past we only evaluated ABO identical donors,” said Hari Reddy Mallidi, MD, Co-Director of Lung Transplant, ECMO and Lung Assist Devices at the Lung Center.

Advanced Technologies: ECMO and EVLP

Technologies utilized in the Lung Center are also helping to expand the number of organs available for transplantation.

Extracorporeal membrane oxygenation (ECMO) is an intensive care technology that takes over the work of the lungs temporarily for patients waiting for transplantations. Acting as a lung, it delivers oxygen to a patient’s bloodstream, allowing time for damaged lungs or a stressed heart to rest and recover.

“We added the ECMO program to three intensive care units to manage patients with acute heart failure, lung failure, or combined heart and lung failure. The system can be deployed rapidly and allows for immediate resuscitation of patients in extremis,” said Dr. Mallidi.

Ex-vivo lung perfusion (EVLP) is a procedure used to minimize swelling in donor lungs in an effort to make them suitable for transplantation. EVLP involves keeping donor lungs ‘breathing’ outside of the body and providing them with nutrients and blood-substitutes. The method also removes white blood cells in the donor lungs, which minimizes the risk of rejection.

“EVLP has the potential to perfuse lungs infected with hepatitis C or pneumonia, for example, with anti-viral medications that would essentially cure the lungs and make them suitable for transplantation,” said Dr. Bueno. “I expect that EVLP will enable us to perform an additional 10 to 20 transplants this year.”

EVLP’s uses may extend beyond transplants as well. For example, queried Dr. Bueno, could a lung with cancer be taken out of a living person, treated with extra-high doses of chemotherapy with EVLP and then be put back in the patient? Investigators in the Lung Research Center – part of the Brigham Research Institute – are exploring these questions.

“These are wonderful examples of how unmet clinical care needs guide research directions,” Dr. Bueno said. “In turn, research results get rapidly translated to new, clinical opportunities for our patients.”

Access to Our Lung Center Services

At Brigham and Women’s Hospital, our specialists are available for timely consultations and will work with you to develop treatment plans for your patients. Our Physician Liaison Ellen Steward can provide direct assistance with patient referrals and consultations. Ellen can be reached at (617) 582-4733 or esteward@partners.org.

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