Surgeons have performed a double-lung transplant using a novel machine which revives donor organs and keeps them alive and breathing outside the human body. The operation marked the first time the machine has been used in the UK.
The pioneering device consists of a bubble-like chamber which contains a series of pumps and filters that repair, recondition and revitalise the lungs before they are transplanted into patients.
Perfusion of the lungs in the machine allows doctors to evaluate and, if necessary, rehabilitate the organs for transplant. It also buys them significantly more time than the traditional method of storing lungs on ice, which can cause tissue damage.
Experts say the machine’s arrival could dramatically increase the number of lungs available for transplant on the NHS, potentially saving hundreds of lives a year. Daniel Evans-Smith, 49, was the first patient in the UK to benefit from the XPS system, which is made by Xvivo.
Before the operation at Royal Papworth hospital in Cambridge, Evans-Smith, an events manager, had developed chronic obstructive pulmonary disease (COPD), a condition that causes breathing difficulties and can worsen over time, limiting daily activities and sometimes requiring the use of oxygen.
After getting new lungs from a donor patient that were brought back to life using the XPS system, he woke up to find he no longer had COPD. “It’s amazing,” he said in an interview with the Guardian. “The difference is phenomenal.”
For more than five decades, the typical method for preserving lungs before transplantation was to cool them to just above freezing, slowing down their metabolic processes. This extends the window in which they can be transplanted, though only briefly.
Once cooled, however, it is impossible to properly assess their quality. Because lung transplants are complex and life-changing operations, surgeons tend to refrain from using organs of uncertain quality. It means only one in five donated lungs worldwide end up being used.
By giving doctors more time to examine lungs, the XPS system could mean fewer donor organs are wasted, and more patients get the call to receive a transplant. Evans-Smith was only on the waiting list for nine days.
The Royal Papworth team that performed the first surgery with the XPS system in the UK used a technique called ex-vivo lung perfusion (EVLP).
EVLP is a technique used widely in Europe and the US but has not been common practice in the UK. There have been a small number of EVLP transplants in the UK before, largely limited to clinical trials or relied on different machines.
Since their success with Evans-Smith, surgeons have performed transplants on three more patients using the XPS system.
The machine mimics the environment of the human body, allowing the lungs to inflate and deflate as normal. A special fluid maintains them and helps to restore normal function, allowing them to be maintained and even improved. The lungs can be preserved in this way for up to six hours.
If they perform well over at least three hours of testing, they are removed from the system ready for transplantation.
Evans-Smith was operated on by a multidisciplinary team led by the consultant surgeons Marius Berman, Giuseppe Aresu and Pradeep Kaul. After rehab in critical care and then on the surgical ward, he returned home to Northampton recently to continue his recovery.
Berman, the surgical lead for transplantation at Royal Papworth, said: “We are very proud to have become the first UK hospital to use this machine for a clinical ex-vivo lung perfusion case, which has helped to provide Daniel with suitable donor lungs. Without this innovation, he may still have been waiting for a transplant today.”
The chair of a national NHS lungs advisory group, Jasvir Parmar, said the machine marks a significant shift in doctors’ ability to evaluate and boost the quality of donated lungs.
“Once you have the lungs out of the body, you are then able to improve their performance, so it provides not just an assessment tool but also a therapeutic tool.”
NHS Blood and Transplant’s national medical director for organ and tissue donation and transplantation, Prof Derek Manas, said the machine could help reduce the organ donor waiting list.
“With more than 200 people currently waiting for a lung transplant, this significantly outweighs the number of suitable donor organs. It is vital that we support innovation to improve the chances that these desperately ill patients will get the call they are waiting for.
“We are grateful for the work to improve transplantation technology and techniques but most of all grateful to the patients and families who agree to save and improve lives through organ donation.”
Evans-Smith is now looking forward to continuing to recover his health over Christmas without the burden of COPD. “Prior to this, I struggled to walk up a hill or to walk any form of distance without having to consider where I be able to stop and rest to catch my breath.
“Now I might be doing 7,000 steps a day, including going up and down hills, and I can do 3,000 steps without even stopping for a breath. It’s just amazing, isn’t it?”
