The Cutting Edge in Lung Transplantation

Washington, DC—“The way we preserve organs is the same as 1983,” when the first successful lung transplant was performed, according to Marcelo Cypel, MD, MSc, FRCSC, of the University of Toronto. Furthermore, there is a very low utilization of donor lungs because of damage or injury, which cannot be repaired or improved with static cold storage.

During a talk titled “The Cutting Edge in Lung Transplantation,” he presented a new method of lung preservation and donor lung repair called ex vivo lung perfusion (EVLP), including research that shows it is safe even in high-risk donor lungs. Benefits include being able to use antibiotics and extending the timeframes when donor lungs can be used, which eases hospital logistics. EVLP is now used clinically in Toronto and other centers, and it has had a significant impact on the number of transplants that can be performed.

University of Pennsylvania’s Jason Christie, MD, MSCE, is performing research to rethink primary graft dysfunction (PGD) and its prevention. Christie’s lab examines mechanisms of clinical factors that elevate PGD risk, including donor smoke exposure, recipient obesity and body composition, pulmonary hypertension, alterations in lung microbiome, and autoimmunity to lung collagens. He said studies are finding that not only obesity but also region of adiposity affect risk. In addition, he reviewed smoke exposure biomarkers (e.g., NNAL), which can give clinicians more reliable quantification of this measure.

Scott Palmer, MD, of the Duke Clinical Research Institute, shared new insights into chronic lung allograft dysfunction (CLAD), which limits long-term survival. “I like that we as a community have started to think of CLAD more broadly,” he said, exploring phenotypes, mechanisms, and treatment.

Studies are beginning to give an emerging understanding of RCLAD and BOS as distinct phenotypes. As the phenotypes continue to be defined, Palmer encouraged the audience to try to elucidate the link between CLAD risk factors and the mechanistic pathways. “We have ideas, but we really don’t know what works,” he said. “We need to focus on prevention.”