Editors' ChoiceLung Transplantation

A breath of fresh air for donor lungs

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Science Translational Medicine  29 May 2019:
Vol. 11, Issue 494, eaax9558
DOI: 10.1126/scitranslmed.aax9558


Donor lungs damaged by gastric aspiration can be regenerated to meet transplantation criteria by an interventional cross circulation platform.

A shortage of donor organs results in 20 deaths per day in the United States, and up to 80% of donor organs cannot be used due to damage at the time of death. Gastric aspiration is a common injury that renders donor lungs unusable, and now a study by Guenthart et al. demonstrates a potential intervention.

This article reports a method of extracorporeally supporting donor lungs on cross-circulation from the recipient patient while providing therapeutic interventions aimed at reversing the damage incurred due to gastric aspiration at death. The authors assessed the effects of two therapeutic interventions—airway lavage and alveolar recruitment via exogenous surfactants—on lung regeneration over a 36-hour period after injury in a swine model. The authors found that airway lavage ameliorated the caustic effects of gastric aspiration, normalized pH, and reduced inflammatory cytokine concentrations in lavage fluid. Additionally, mechanical compliance returned to 68% of the average compliance of control lungs, and histological lung injury scores decreased across all categories in the 36-hour treatment period. The authors note several limitations to the study, including (i) the lack of immunosuppression during therapeutic interventions, which would be required in real-world application of this therapy and would likely impact the process of lung regeneration; (ii) a shorter time between gastric aspiration and interventional recovery efforts than typically experienced in the clinic; and (iii) the inability to achieve complete lung recovery. Another limitation to consider is the practicality of cross-circulation with the transplant recipient for 36 hours, which would heighten the risk for opportunistic infection and require immobilizing the recipient for the duration of the procedure.

Despite these limitations, the degree of regeneration and recovery of the donor lungs in this study was substantial, and transplant centers may be able to adopt this promising technique, as well as the benchmarks for lung repair established in this study, to expand their donor pool to lungs damaged by gastric aspiration. It may also be possible to expand this strategy to other organs, which could have broader impact on the global donor organ shortage.

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