Lung Transplant

Research

Enhanced Lung Recovery Project

The Enhanced Lung Recovery Project (ELRP) at UCSF Medical Center conducts basic and clinical research aimed at improving the efficiency of lung donation. The project involves UCSF researchers who work in collaboration with the California Donor Transplant Network.

The project's goals are to:

• Increase and refine data on lung donors and lung injury related to brain death
• Develop new criteria for determining whether donor lungs are suitable for transplantation
• Develop new protocols and educational programs to enhance lung recovery

Three clinical and two basic science research projects have already generated important information.

• In reviewing thoracic organ donor characteristics, researchers found that most potential donors arrive at the hospital with healthy lungs but then experience significant deterioration in lung function. Early administration of high-dose steroids to potential donors was found to be the most significant predictor of successful donation. This finding suggests that the process that causes lung injury following brain death is a treatable inflammatory condition.

• Another study is examining the impact of donor lung infections on transplant success. Data on illness and graft function in patients who received donor lungs with active bacterial infections show good immediate and 12-month outcomes. This preliminary information suggests that the infectious component of the inflammatory state in donor lungs is limited as long as good lung function is still present.

• Interesting preliminary results also have been generated from the ELRP's Donor Radiographic Survey, the largest study of its kind. Researchers evaluated serial films from 110 potential lung donors to determine the role radiographic abnormalities played in determining whether lungs were suitable for transplantation. Thirty percent of potential lung donors were found to have significant lung densities at the time of initial admission, and up to 60 percent of these densities resolved completely. In 30 percent of the potential donors, however, these improvements did not affect successful lung donation, whereas worsening lung infiltrates were found to be associated with rejection of donor lungs for transplantation.

  An additional, independent predictor of lungs being rejected for transplantation was an increased number of abnormal radiographic diagnoses on the final chest films. This study emphasizes the changing nature of radiographic findings in potential lung donors and the need for expert evaluation prior to the decision to proceed with transplantation.

• ELRP researchers are examining lung injury and associated clinical characteristics in lungs rejected for transplantation. In the majority of lungs, the degree of lung swelling and lung injury as measured by the fluid-handling properties of lung cells is much less than would have been expected based on donor clinical characteristics. The goal of this work is to provide thoracic transplant physicians with measures for assessing the appropriateness of the clinical criterion used for donor selection.

• In the first experiments of their kind, researchers are profiling gene expression following brain death in lungs rejected for transplantation. These studies have revealed important new information about the cellular mechanisms associated with the inflammatory state following brain death. The information gained in this study will provide a better understanding of the pathophysiology of brain death and possible avenues for therapeutic intervention.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007