Lungtransplantation

Projekt: Forskning

Forskningsområden

Ämnesklassifikation (UKÄ)

  • Klinisk medicin

Beskrivning

BACKGROUND
Professor Stig Steen’s research group has accomplished 4 major breakthroughs in clinical lung transplantation.

1. Safe Lung Preservation for 24 hours

Until the publications of 2 articles by Steen’s group (Steen, et. al., Ann Thorac Surg 1994; 57:450-7 and Steen, Prog Appl Microcirc 1996; 22:50-60) Eurocollins solution was used world wide to preserve donor lungs for transplantation. It gave preservation time of 6 hours. Today 90% of the lung transplantation centers in the world use the method of lung preservation developed by Steen’s group that allows safe preservation for 24 hours.

2. Transplantations of lungs from uncontrolled non-heart-beating donors (NHBD) after ex-vivo evaluation.

About 50% of the deaths in the Western world are caused by cardiac and cardiovascular disease. Steen’s group has shown how this group potentially could be a very large source of lung donors. To accomplish this, ethical research and the development of an ex-vivo method to evaluate lung function caused the first clinical transplantation in the world to be performed with this method in 2000 (Steen, et. al. Lancet 2001; 357:825-29). When fully accepted, this method has the capacity to completely eliminate the lung donor shortage.

3. Lund University Cardiopulmonary Assist System (LUCAS)

In order to get ethics permission to use victims of cardiac arrest after failed resuscitation as a lung donor, one precondition was that everything possible had been done first to save the life of the victim of cardiac arrest. Steen’s group therefore started research into cardiac arrest with that intention. The results of this research led to the development of the mechanical chest compression device LUCAS (Steen et. al. Resuscitation 2002; 67:25-30 and same journal 2005; 67:25-30). LUCAS is now spreading around the world, and has created a new special type of donors, namely patients with cardiac arrest who receives LUCAS-treatment resulting in spontaneous adequate circulation, but later develop brain death due to severe brain injury in connection with the cardiac arrest (Ingemansson, et. al. Ann. Thorac. Surg. 2009; 87:255-60).

4. Reconditioning of initially rejected donor lungs due to insufficient gas exchange capacity

Only about 20% of heart-beating donor lungs are accepted for transplantation. With the ex-vivo method developed for NHBD lungs, we have demonstrated that edemateous donor lungs can be dried up ex-vivo and regain adequate function. The first transplantation in the world with such a reconditioned lung was done in 2005 (Steen et. al. Ann. Thorac. Surg. 2007; 83:2191-5) and in January 2009 we published the 2-year follow up of 6 double lung transplantation done with this method (Ingemansson, 2009).

RESEARCH POWER AND FUTURE POSSIBILITIES
Professor Stig Steen has founded his own research facility Igelösa Life Science Community. In 2008 the Swedish biotech company Vivoline Medical AB was founded in order to develop all necessary components for a high tech device for automatic ex-vivo evaluation of lungs. In April of 2009 the company received grant from Vinnova, a stately owned innovation promoting organ, and by the end of 2009 the system Vivoline LS1became the world’s first CE-marked device for ex-vivo lung perfusion.

A majority of the leading lung transplantation clinics in the world have visited Lund to participate in courses in ex-vivo lung preservation, evaluation and reconditioning. With this new method, donor lungs can be stored for several days, allowing ex-vivo therapy and tissue typing before a suitable recipient can be transplanted in day time by a senior surgeon without sleep deprivation.
StatusEj startat

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