April 2022

PULMONARY

"LUNG IN A BOX" NOW OFFERED AT NORTHWESTERN MEDICINE

Featuring: Ankit Bharat, MBBS, Rafael Garza-Castillon, MD
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Ex vivo lung perfusion (EVLP) allows transplant surgeons to examine lungs outside the body

Due to COVID-19 and a rapidly expanding list of conditions for which lung transplantation can be lifesaving, the need for new organs is growing. However, with a global shortage of donated lungs, some patients die while on the waitlist. To help expand the donor pool, Northwestern Medicine is now using a device from XVIVO called XPS™ which is used for ex vivo lung perfusion (EVLP) – nicknamed “lungs in a box” – to rescue potentially viable lungs and those initially deemed “unacceptable” for transplant. Out of all solid organs, lungs have the lowest utilization, with only one in five donated lungs getting transplanted.

“EVLP allows us to take donor lungs outside the body, attach them to a ventilator and make them clinically usable by treating infection, inflammation and edema – it’s visually stunning,” said Ankit Bharat, MD, chief of thoracic surgery at Northwestern Medicine and executive director of the Canning Thoracic Institute, who pioneered COVID-19 lung transplants in the United States. “Because we were the first health system in the U.S. to offer lung transplants for COVID-19 patients, our patient volume continues to increase, and we need every tool to help us get more patients transplanted. EVLP will give us the ability to fix lungs that don’t appear usable up front.”

In January 2022, Northwestern Medicine surgeons used EVLP for the first time to secure viable lungs for Mike Piwowar, a 65-year-old from Waukegan, Ill., who was waiting for a lung transplant due to chronic obstructive pulmonary disease (COPD). Piwowar, an avid fisherman and woodworker, had a rare blood type, which made finding a potential match difficult.
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“It was getting to the point where more things were going wrong with my body than right. If I did any kind of exertion, I was out of breath,” explains Piwowar. “Once I was officially on the transplant waitlist, it only took a few weeks to find a match. My family was in shock because we thought it would take much longer.”

“We got a call about a set of lungs that matched Mike’s blood type but were turned down by other hospitals due to possible lung damage,” explained Dr. Bharat. “We said, ‘let’s get the lungs here and see if we can repair them by using EVLP.’ Because Mike’s blood type was so rare, we knew this could be our only chance to find a suitable match.”

Rafael Garza-Castillon, MD, a thoracic surgeon with the Canning Thoracic Institute at Northwestern Medicine, retrieved the donor lungs and brought them back to Northwestern Memorial Hospital. Once inside the operating room, the donor lungs were attached to a ventilator, allowing them to expand and be kept at body temperature for up to five hours, giving surgeons the opportunity to survey their suitability for transplant. Blood samples were taken directly from the pulmonary vessels to assess gas exchange, and a chest X-ray and bronchoscopy were performed, allowing surgeons to look for and treat issues such as infection, lung collapse, swelling and pulmonary embolisms.

“Typically, when we’re evaluating donor lungs, we have the chest open, but we can only directly assess the lungs for a brief period and it’s difficult to survey the most posterior portions. EVLP allows us to do a 100% assessment of the donor lungs outside the body for a prolonged period of time,” said Dr. Garza. “With this set of lungs, they turned out to be better than what they looked on paper, and all the tests came back reassuring. Today, Mike is doing well, and it’s a gratifying feeling to know we helped another patient go home off oxygen and start a new chapter of their life.”

“It’s pretty amazing that they could do something like ‘lungs in box.’ My first thought went to the old movie, Frankenstein, where they keep organs alive outside the body,” said Mike’s wife, Debbie Piwowar. “Before his transplant, Mike was struggling to breathe and walk. Now, thanks to his new lungs, he’s getting so much stronger. I can’t wait to see him go fishing again.”

Northwestern Medicine performed 73 lung transplants in 2021, including their first double-lung transplant on a patient with terminal lung cancer. In June 2020, Northwestern Medicine surgeons performed the first double-lung transplant on a COVID-19 patient in the United States. To date, almost 50 COVID-19 patients have received lung transplants at Northwestern Medicine.

For more information on Northwestern Medicine’s Lung Transplant Program, visit nm.org.

This article was originally published in the Northwestern Medicine Newsroom on April 7, 2022.
Ankit Bharat, MBBS, is the chief of Thoracic Surgery in the Department of Surgery, Harold L. and Margaret N. Method Research Professor of Surgery and associate professor of Surgery (Thoracic Surgery) and Medicine (Pulmonary and Critical Care). Dr. Bharat specializes in malignant and benign chest and esophageal diseases. His research focuses on lung preservation, transplant immunology and airway biology, achieved through collaboration with the Kovler Comprehensive Transplant Center and the Division of Pulmonary and Critical Care Medicine.
Rafael Garza-Castillon, MD, instructor of Thoracic Surgery in the Department of Surgery. He is a general thoracic surgeon with experience in minimally invasive surgery for benign and malignant airway, lung, esophageal and anterior mediastinal diseases.

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