August 1, 2019

VUMC performs its first transplant using rehabilitated lungs

For the first time at Vanderbilt, doctors have performed a transplantation with donated lungs that were rehabilitated using a procedure called ex vivo lung perfusion.


Rebecca Milligan, here with her daughter, Cindy Wheeler, recently became the first patient at VUMC to receive a transplant with donated lungs that were rehabilitated using a procedure called ex vivo lung perfusion. (photo by Steve Green)

by Matt Batcheldor

Rebecca Milligan was fighting to stay alive, but time was running out. In February, her pulmonologist told her that her lungs were failing and she had maybe six months to live. The 62-year-old from Palmer, Tennessee, was placed on the transplant list at Vanderbilt University Medical Center, but finding the right lungs for her was a challenge.

Then in June, for the first time at Vanderbilt, doctors transplanted her with donated lungs that were rehabilitated using a procedure called ex vivo lung perfusion (EVLP). The procedure, which involved sending donor lungs to a laboratory in Maryland for perfusion before implantation at Vanderbilt, salvaged organs that were previously unsuitable for transplant and saved Milligan’s life.

Now Milligan can be found walking around the track at Dayani Center, recovering with her two new lungs. “I feel miraculously great,” she said. “I just feel wonderful. Vanderbilt did a really good job.”

Milligan’s surgeon, Matthew Bacchetta, MD, MBA, MA, associate professor of Thoracic Surgery, said his patient’s surgery marked a number of firsts. It was also the first time Vanderbilt used lungs that were DCD (donation after cardiac death), which are more challenging to transplant than lungs that are typically gathered after brain death. Milligan’s new lungs were preserved for 19 hours and 47 minutes before transplantation, one of the longest documented times of total preservation and the longest at Vanderbilt.

“There are very few programs that have demonstrated an ability to manage these well over 12 hours, and we were just under 20 hours,” Bacchetta said.

About 80% of donor lungs are too damaged to be considered for transplantation, but Bacchetta said the EVLP procedure has the potential to increase the limited supply of donor lungs and help save the lives of more people who would otherwise die waiting for a match. The technique also shows promise in keeping organs alive longer so that doctors have more time to monitor how well the donor organ is performing before deciding to transplant it. That leads to better outcomes.

“It’s not just about the numbers; it’s really about the quality of the match for the recipient,” Bacchetta said. In Milligan’s case, “the lungs were very good and showed excellent function, and so we decided we would utilize them for her transplant.”

Only a few centers in the United States offer the EVLP procedure; Vanderbilt is part of a clinical trial that is studying a more expanded use.

“Dr. Bacchetta is a true pioneer in this therapy,” said Seth Karp, MD, H. William Scott Jr. Professor and chair of the Section of Surgical Sciences and director of the Vanderbilt Transplant Center. “Through his work and that of his team, Vanderbilt is an international leader in this field and able to offer life-saving therapies to our patients that we could only dream about just a few years ago.”

Milligan’s daughter, Cindy Wheeler, said she is amazed at how well her mother is living with her two new lungs. Before surgery, she could only take a few steps, and she carted around more than a dozen oxygen tanks behind her to go to her medical appointments. But she soldiered on, without complaint.

Now, “she doesn’t cough anymore,” Wheeler said. “She’s up moving around. One day last week she made breakfast for me.”

She credits the EVLP procedure. “That’s amazing to be able to take that little organ and make it what it needs to be,” she said. “It’s almost like you’ve given it a little love.”