Ann Thorac Surg 2006;81:466
© 2006 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
John Conte, MD
Division of Cardiac SurgeryJohns Hopkins Medical InstitutionsBlalock 618, 600 N Wolfe StBaltimore, MD 21287
(Email: jconte{at}csurg.jhmi.jhu.edu).
Wierup and colleagues [1] report the use of machine perfusion to restore unacceptable donor lungs into a physiological condition compatible with lungs acceptable for transplantation. This report is welcome news to the many investigators who have long held onto the possibility of using pump perfusion of donor lungs for the purpose of organ preservation or organ resuscitation.
The senior author, Steen and his colleagues [2] have previously reported the use of this perfusion apparatus to preserve donor lungs from nonheart beating donors. In this report they use the same system to demonstrate that human lungs deemed nontransplantable, on the basis of low arterial oxygen tension, can be resuscitated through normothermic perfusion using Steen and colleague's [2] solution, combined with blood to a hematocrit of approximately 15% into a usable state. If these results were found to be reproducible in future, more rigorous studies, the algorithm of evaluating donor lungs could possibly change. This may mean more lungs for transplantation, better lungs for transplantation, the opportunity for cellular and subcellular level intervention, and daytime transplants!
However, before we begin celebrating this new source of donor lungs, we should remember that this concept is not new and we have tried it before [3]. The early efforts at machine preservation failed, largely due to tissue edema. Such systems were also abandoned, even in lungs deemed acceptable for transplantation a priori. Although throughout their article, Steen and colleagues [2] refer to the potential of drying out lungs using their system, no evidence is given to support this idea. We must also remember that just because we see an improvement in PaO
2 in this model, this does not mean we are ready to begin transplanting humans, and there are many logistical issues to be addressed. This report leaves more questions unanswered than it answers, and we will have to see if resuscitated lungs can withstand the challenge of transplantation after resuscitation in large animal models.
Despite this, the authors are to be congratulated. This report is significant and exciting, but we will just have to see if this technology will result in poor quality donor lungs being able to be resuscitated and successfully transplanted.
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References
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- Wierup P, Haraldsson Å, Nilsson F, et al. Ex vivo evaluation of nonacceptable donor lungs Ann Thorac Surg 2006;81:460-466.[Abstract/Free Full Text]
- Steen S, Sjoberg T, Pierre L, et al. Transplantation of lungs from a non heart beating donor Lancet 2001;357:825-829.[Medline]
- Hardesty RL, Griffith BP. Autoperfusion of the heart and lungs for preservation during distant procurement J Thorac Cardiovasc Surg 1987;93:11-18.[Abstract]
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