Optimizing Outcomes of Lung Transplant for Patients With Lung Failure (Podcast)

Demand for usable donor lungs for transplant in the United States still outstrips supply despite decades of efforts to close the gap. A leading tool in those efforts has been the emergence of ex vivo lung perfusion (EVLP) as a reliable method of rehabilitating marginal donor lungs to make them suitable for transplantation.

“EVLP has been a focus of our program over the past decade,” says Kenneth McCurry, MD, Surgical Director of the Lung and Heart-Lung Transplantation Program at Cleveland Clinic. “In recent years EVLP has enabled us to transplant an additional 30 to 40 patients a year, with outcomes that are as good as or better than lungs that we take straight to transplant. We think there’s still more opportunity to offer lungs to more patients using this sort of strategy.”

Those perfused donor lungs help Cleveland Clinic maintain its rate of 130 to 150 lung transplants per year, placing it among the highest-volume programs in the nation.

In a recent episode of Cleveland Clinic’s Cardiac Consult podcast, Dr. McCurry joins Marie Budev, DO, Medical Director of the Lung Transplantation Program, to discuss various aspects of lung failure treatment and transplant. They touch on the following topics, among others:

• Specifics of EVLP and other recent advancements in lung transplant
• The importance of aggressive donor organ procurement and utilization
• Extended criteria for patient selection
• Post-transplant research and clinical trials
• Management of cardiovascular issues in lung transplant patients
• Caring for older lung transplant recipients
• Use of ECMO and related technologies for critically ill patients

Click the podcast player above to listen to the 24-minute episode now or read on for an edited excerpt. Check out more Cardiac Consult episodes at clevelandclinic.org/cardiacconsultpodcast or wherever you get your podcasts.

Excerpt from the podcast

Marie Budev, DO: Ken, you made a great point that there are more donors out there that are not being utilized. There continue to be thousands of patients dying on the waiting list for lungs. What else are we doing at Cleveland Clinic in terms of donor selection that’s distinctive?

Kenneth McCurry, MD: Our approach — and I think this is part of the culture of our program here — is that our default answer to an organ is “yes,” and we have to find reasons to say no. That’s our guiding principle, and this may not be the case across the country.

Sometimes transplant donor offers come at inopportune times, when surgeons and medical pulmonologists and other team members are busy doing other things. Other times there are questions of donor lung marginality or something similar, and that can be a common reason why organs are declined.

We start from the premise that an organ is suitable for transplant, and it really has to be proven to us that it’s not, including with the use of EVLP. We are very aggressive in going out to look at donor organs. We do things to try to make those organs better, both in the OR when harvesting the donor organ and ultimately, if necessary, using EVLP. This allows us to utilize a lot of organs that otherwise would have gone to waste.

Let me ask you, Marie, how our program goes about the evaluation process and how we’ve extended the criteria to complex patients and patients with other difficulties for transplantation that perhaps other programs won’t consider transplanting.

Marie Budev, DO: Over the past decade or more, Cleveland Clinic has approached the patient the same way we approach the donor, actually. You have to show us you are not going to be an appropriate candidate. We are taking highly complex patients with multiple comorbidities. These could be cardiac comorbidities, for instance, or issues with the gastrointestinal tract, such as reflux. We feel comfortable handling and transplanting patients who may be turned down at other institutions for other medical reasons. About 30% of our referrals are from other institutions, and about 30% of our patients that we do transplant have been referred from another hospital where they had been turned down for transplant.