XVIVO Lung Perfusion System increases transplant options

Robin Thomas lived one struggling breath at a time.

Diagnosed with end-stage chronic obstructive pulmonary disease, her only option for survival was a lung transplant. However, the odds of finding a set of donor lungs did not appear to be favorable. By some estimates, nearly 80 percent of donor lungs are unsuitable for transplant.

But an innovative technology at UF Health gave Thomas new hope. Known as the XVIVO Lung Perfusion System, the technique allows surgeons additional time to evaluate a set of donor lungs. In some cases, lungs otherwise not viable for transplant can be rehabilitated.

In February, Thomas received a new set of lungs at the hands of Tiago Machuca, MD, PhD, an assistant professor in the division of thoracic and cardiovascular surgery and a lung transplant surgeon who leads UF Health’s lung perfusion program.

“That first breath was amazing,” Thomas said. “Before the transplant, it took me hours just to make a sandwich.”

She couldn’t play with her dog, Harley, a rambunctious Australian Cattle Dog. Thomas was limited by the 50 feet of tubing connected to her oxygen machine. Each day, she did less as her condition grew worse.

Thomas was the first patient at UF Health to receive a pair of lungs placed on the XVIVO system. To date, UF Health surgeons have performed at least four such transplants.

The machine, called XPS, pumps a special preservation solution along with oxygen into the lungs to maintain and possibly improve their health outside the body. The lungs contract and expand inside the XPS for hours, allowing transplant surgeons to assess them over time.

Machuca estimates that 50 to 60 percent of donor lungs placed on XVIVO become suitable for transplant.

“Some lung damage, like pulmonary edema or impaired gas exchange, is reversible,” Machuca said. “If those conditions are addressed, the lungs may be excellent candidates for successful transplant.”

Traditionally, a surgeon at the medical center offering the lungs evaluates the lungs considered for transplant, while the organs remain inside the donor. Such assessments may not provide all the information the transplanting surgeon desires, and it can be difficult to reach conclusions about the organs’ viability at that point in the process.

“The function of most of these lungs can now be improved by use of the XVIVO system,” Machuca said. “This technique will help to expand the pool of acceptable donor lungs, hopefully shortening the waiting period for donor lungs and preventing deaths of those whose health condition cannot afford the wait time.” Thomas is grateful to be among those patients who have benefited from the XVIVO system. She recently celebrated her 60th birthday — a milestone she feared she would not reach.

“I went to a cookout with friends, and my niece came down from Ohio to celebrate with me,” she said. “A year ago, none of this would have been possible.”

UF Health obtained the XVIVO Lung Perfusion System in 2014. It is one of 15 organizations nationwide testing the lung perfusion system. The device is currently approved by the U.S. Food and Drug Administration.

“XVIVO gives us a comfort zone to accept lungs that we can actually transplant directly if we find they are suitable,” said Thomas M. Beaver, MD, a professor and chief in the division of thoracic and cardiovascular surgery at the UF College of Medicine. “UF Health is now among the most active XVIVO programs in the country thanks to Dr. Machuca.”