The preservation time of donor lungs after isolation has been prolonged from 6 hours to 12 hours, gaining valuable time for patient treatment. On Feb. 18th, Renmin Hospital of Wuhan University won the first prize of the 2020 Provincial Science and Technology Progress Award at the Hubei Provincial Science and Technology Innovation Conference for its research on a major key problem in lung transplantation. The expert group unanimously agreed that this technical achievement reached the international leading level.
As one of the major advances in modern medicine, organ transplantation is developing rapidly in China, with nearly 15,000 large organ transplants each year. Among them, lung transplantation is the “most difficult one” in terms of technical and management difficulties. According to reports, there are currently over 40 hospitals qualified for lung transplantation nationwide, but no more than 15 of these are capable of performing lung transplants independently. In 2020, there were nearly 500 lung transplantation surgeries performed nationwide, which was far fewer than the number of liver and kidney transplantation.
The project leader, Professor Geng Qing, introduced lung transplantation as the only treatment for end-stage lung disease, which can effectively improve the quality of life and prolong the life span of patients with end-stage lung disease. While lung ischemia-reperfusion injury is the main cause of function insufficiency of transplanted lungs after lung transplantation, it is also a high-risk factor for acute and chronic rejection and bronchiolitis obliterans after surgery, which seriously affects short-term and long-term survival rates of patients, and has become the focus of lung transplantation research internationally.
Since the start of lung transplantation at the end of 2017, the team of Prof. Geng Qing and Prof. Lin Huiqing from the Department of Thoracic Surgery of Renmin Hospital of Wuhan University has been working together with Prof. Chen Jingyu’s group from Wuxi’s Renmin Hospital to carry out research on the mechanism of lung ischemia-reperfusion injury and key clinical technology innovation in lung transplantation and to break through its bottlenecks. Through nearly three years of research, the research group has discovered the interaction between autophagy and ubiquitin-proteasome pathway in pulmonary ischemia-reperfusion injury, providing a new therapeutic strategy for lung ischemia-reperfusion injury after transplantation for the first time; it has also detected the important regulatory role of natural immunity in lung ischemia-reperfusion injury for the first time, providing a new potential therapeutic target for the prevention and treatment of lung ischemia-reperfusion injury after transplantation.
By breaking through a series of key challenges, the lung transplantation team of Renmin Hospital has continued to improve the utilization rate of donor lungs, especially “marginal donor lungs”, bringing hope to many desperate patients with lung failure who yearn for a new life. The hospital’s thoracic surgery department has performed 21 lung transplants in the past three years, and it has teamed up with the cardiac surgery department to successfully perform the first combined heart-lung transplantation in Hubei Province. The farthest lung source was expanded from the previous 1,000 km radius centered on Wuhan, reaching border areas such as Hainan and Yunnan.
The thoracic surgery team’s application of research findings in the field of donor lung ischemia-reperfusion has significantly improved the quality of the donor lung. The incidence of early pulmonary graft dysfunction (PGD) in patients after lung transplantation was extremely low, and the quality of patients’ lives after surgery was significantly improved. In particular, the lung transplantation team’s application of the enhanced recovery after surgery concept (ERAS) to lung transplantation, significantly shortening the postoperative recovery time to as little as 13 days for single-lung transplant patients.
This research result is of great clinical significance and social value in improving the success rate of lung transplantation, expanding the lung donor pool, enhancing the safety of marginal donor lung transplantation and carrying out emergency rescue lung transplantation. The research results have been disseminated in more than ten large tertiary hospitals nationwide with eight related authorized patents and nine guidelines, specifications and expert consensus on them, which are important for the basic and clinical research of lung transplantation and the standardized and orderly development of lung transplantation in China.
In addition to this, Prof. Geng Qing and Prof. Lin Huiqing’s group has also innovated techniques to save lives in lung transplantation practice. For patients with progressive heart failure during lung transplantation, they have implemented emergency intraoperative V-A ECMO (veno-arterial extracorporeal membrane oxygenation) with right atrial and aortic circulation lines on the basis of VV-ECMO (veno-venous extracorporeal membrane pulmonary oxygenation). The application of this modified dual ECMO system can effectively maintain patients’ cardiopulmonary function, provide continuous cardiopulmonary life support, and improve the safety of lung transplantation.
In the fight against the COVID-19 pandemic in 2020, the multidisciplinary team of Renmin Hospital of Wuhan University has been courageous in innovating to expand the indications for lung transplantation. Lin Huiqing teamed up with Chen Jingyu’s group to use lung transplantation for the treatment of end-stage severe pulmonary fibrosis of COVID-19 and successfully carried out the first case of end-stage lung transplantation for COVID-19 in Hubei.
It is reported that at the Hubei Provincial Science and Technology Innovation Conference, Renmin Hospital of Wuhan University (Hubei General Hospital) has won seven awards, including five Scientific and Technological Progress Awards, one Scientific and Technological Achievements Promotion Award and one Technological Invention Award.
Written by: Du Weiwei
Rewritten by: Li Tiantian
Edited by：Chen Muying
