Transplanting lungs from smokers worthwhile

Lung transplant patients who receive the organs from smokers have better chances of survival than those who stay on waiting lists a British study suggests

Nearly 40 per cent of the lungs that are available for transplant including those in Canada are from smokers

Rejection of this donororgan resource would increase waitinglist mortality and is ill advised lead author Professor Robert Bonser of the Queen Elizabeth Hospital in Birmingham and his coauthors concluded in Tuesdays online issue of the medical journal The Lancet

Dr Marcelo Cypel left and Dr Shaf Keshavjee deliver gene therapy into human donor lungs to try to repair structural damage to the organs AAASScienceCanadian Press
Organ donation rates arent high enough to meet the demand the researchers noted

Over a decade the number of people waiting for a lung transplant more than doubled with 252 Canadians waiting to receive a transplant in 2006 compared with 119 in 1997 according to the Canadian Institute for Health Information Between 1997 and 2006 299 people died while waiting for a lung transplant

In the UK study researchers looked at survival rates for 2181 adults who were waiting for lung transplants between 1999 and 2010 During that time 1295 lung transplants took place

Those receiving lungs from smokers were 146 times more likely to have died three years after transplantation than those who received lungs from nonsmokers investigators found

But compared with those who remained on the waiting list during the study period the chance of death after registration was 21 per cent lower for patients who received lungs from smokers

The importance of the paper was showing the survival benefit of receiving lungs from smokers said Dr Shaf Keshavjee of the Toronto Lung Transplant Program at University Health Network

The other side of the coin is they die Keshavjee said

The risks of not accepting an available lung from a smoker were higher for sicker patients

The situation should be fully explained and discussed with lung transplant patients the researchers stressed

Keshavjee wrote a journal commentary on the research exploring how to expand the pool of lung donors

Repairing lungs
The studys authors assumed an average smoking history because it was difficult to estimate how many cigarettes were smoked per day from information provided by next of kin alone

Lung damage from smoking varies with some showing pronounced damage that leads to obstructive lung disease while others keep functioning despite years of lighting up the commentary noted

Keshavjee said his goal is to make lungs last forever through research and improvements in medical care

Toronto doctors have developed an exvivo system that includes a bubble that acts like a life support system to keep lungs breathing for 12 to 18 hours at normal body temperature

The technological approach offers a chance for some lungs that were previously damaged to recover outside the injurious environment of the body Keshavjee said

Once better strategies are developed to select donor lungs accurately with predictable early and late outcomes many more organs in the donor pool can be used safely and effectively Keshavjee and his colleague Dr Marcelo Cypel wrote

Keshavjee is studying the use of gene therapy and a patients own stem cells to also try to repair structural damage to lungs

The UK research was funded by National Health Service Blood and Transplant

Date : 29 May, 2012
Reference : http://www.cbc.ca/news/health/story/2012/05/28/lung-transplants-smoking.html

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