Ex vivo perfusion now enables the condition of potential donor lungs that are of poor quality to be improved or “repaired” prior to transplantation. Lungs that previously would not have been used are demonstrating an impressive improvement in their function, enabling them to be transplanted, thanks to this method in which the organ is connected to a ventilator and flushed. Current studies in the University Department of Surgery at the MedUni Vienna are now set to reveal whether ex vivo perfusion also offers further potential improvements for high-quality lungs.
“This would enable us to further prolong the lifetime of lungs that are already strong. The initial signs are there,” says Walter Klepetko, who has been Head of the Lung Transplant Programme at the MedUni Vienna / Vienna General Hospital for more than 20 years. Around 120 lungs are transplanted here every year – numbers that are only matched by centres in Hanover, Pittsburgh and Cleveland.
A giant pool of donor lungs
What makes the Vienna programme so unique is that, at the MedUni Vienna’s University Department of Surgery, all donor lungs from Slovakia, Hungary, Croatia, Slovenia, Greece, Cyprus, Romania and Estonia are also transplanted since these countries do not have a transplant centre of their own.
Says Klepetko: “Because we receive more lungs than we need, it’s a win-win situation for everyone. The entire world is envious of us.” Patients from Austria, the countries listed above, but also from other countries who are members of Eurotransplant, the central coordination office for organ donations in Europe, can be provided promptly with organs from this giant pool. “If we didn’t have the option of accessing so many organs, we wouldn't be able to provide Austrians waiting for donor lungs with organs so quickly.” Currently, around two-thirds of the lungs that are transplanted in Vienna come from the eight cooperating countries with a total of around 63 million inhabitants.
Shorter waiting lists for donor lungs
Surgical developments such as the complete division of a left lung lobe and its use for bilateral transplants, the increasingly common living lung transplant (in which a lung lobe is transplanted, usually from the father and mother, into a child) or technological achievements such as the use of extracorporeal mechanical oxygenation (ECMO) systems in the context of transplants, fields in which Vienna surgeons are world leaders, ensure the best possible supply.
The result: patients in Vienna wait around half the time of patients in other Eurotransplant countries for a lung transplant (182 compared to 359 days). The quality of the procedures is also quantifiable: 83 per cent of the patients who received transplants at the MedUni Vienna after 2000 live at least one year, and 65 per cent at least five years. Says Klepetko: “These are brilliant figures in an international comparison.”
European Transplant Congress in Vienna
From next Sunday (8.9) until 11 September, the Austria Center Vienna will play host to the 16th Congress of the European Society for Organ Transplantation (ESOT). The event’s motto is “Pushing the limits”, and its keynote speaker is the three-times Formula 1 World Champion Niki Lauda, who has himself undergone numerous kidney transplants. Further information: http://congress.esot.org.