Alberta Transplant Institute teams up with industry, AHS for international research trial

FoMD staff - 26 June 2013

Faculty of Medicine & Dentistry clinicians are participating in an 18-centre, international research trial to examine the effectiveness of a new technology on health outcomes for lung transplant patients. The Edmonton site is the only centre in Canada taking part in the industry-led trial.

The INSPIRE trial is led by U.S.-based TransMedics and involves technology to oxygenate and possibly repair donor lungs leading up to transplant. The company's goal is to enroll 264 patients in a randomized, controlled trial which will compare two transplant methods - putting donated organs on ice prior to transplant versus using the company's technology to oxygenate and repair organs (through such methods as delivering antibiotics, removing secretions and inserting stem cells). The trial will examine patients' recovery time and quality of life post-transplantation in both groups. The technology may make organ transplantation more effective and safer in the future.

The Faculty joined the research trial this spring thanks to various partnerships. TransMedics donated the portable hardware equipment to the faculty's Alberta Transplant Institute (ATI) and Alberta Health Services (AHS).

"We are very excited to be taking part in this international trial - the technology is very exciting," says Atul Humar, Director of the ATI and a renowned transplant researcher.

"Because members of the Faculty chose to take part in this research trial, Albertans desperately waiting for a lung transplant will have access to the latest medical technology that could improve their recovery time and quality of recovery. This is an example of how Faculty research makes a real difference and positive impact in the everyday lives of Albertans - by improving their health and giving them the gift of time."

Department of Surgery colleague Jayan Nagendran is the lead cardiac thoracic surgeon involved in the trial at the Edmonton centre. He is also a member of the ATI and the director of research for the Division of Cardiac Surgery in the Faculty of Medicine & Dentistry.

To date, 139 patients have taken part in the trial, including two from Edmonton. The remaining patients are from Canada, the U.S., Europe and Australia. The trial, which started in 2012, will wrap up at the end of this year. Interim results from the trial's first 100 patients were publicly shared at the Heart and Lung Transplantation annual meeting in Montreal this spring. Preliminary results are encouraging to the company and investigators.

In addition to the international research trial, the ATI and Alberta Health Services are using the new technology to try to improve the viability of donated lungs - to make them more suitable for transplants. The ATI and the University Hospital Foundation together donated more than $500,000 towards this clinical advancement. The foundation committed $350,000, which reflects the foundation's long-term commitment to advancing the transplant program; in 2005, the foundation contributed $1 million to establish the ATI.

Each time the technology is used, the donated organ sits in a chamber with connections to ventilators and other hardware. The chamber needs to be replaced for each transplant. The funding will pay for 10 or 11 new chambers over the course of a year.

"If we can oxygenate and perfuse donated organs and improve their function to the point they are useful and you can transplant them, it could increase the number of viable organs for transplants in Alberta. This means more transplants could be performed in the province and that is wonderful news for Albertans awaiting transplants," says Humar.

Nagendran noted lungs from western Canada and California were turned down by other hospitals, but the TransMedics technology improved the organs to the point they could be used for transplant. The operations and subsequent recoveries have been successful for the patients, he says. The organs donated from B.C. set a world record for the longest stretch of time that organs have been outside the body prior to a successful transplant - 10.5 hours in the TransMedics chamber technology. The previous record was between seven and eight hours, he says.

"This funding allows us to use the latest technological advancements in transplantation so we can try and save the lives of more patients," says Nagendran. "With this technology, we can start repairing and oxygenating the donated lungs moments after they are removed. This starts the repair process immediately and decreases the risk of injury to the organs, which can occur while organs are cold and stored in ice for hours."

The majority of organs donated for transplant can't be used; 80 per cent of donated lungs are considered not suitable for transplantation. Each year in Alberta, between 30 and 40 lung transplants are performed. Humar and Nagendran both hope that number could dramatically increase using the new technology.