Novel Lung Trial: Normothermic Ex Vivo Lung Perfusion (Evlp) As An Assessment Of Extended/Marginal Donor Lungs

Lung Transplant Clinical Trial

Official title:

Novel Lung Trial: Normothermic Ex Vivo Lung Perfusion (Evlp) As An Assessment Of Extended/Marginal Donor Lungs

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01365429
• Other study ID #: VSS-NA-001, XVO-NA-002
• Status: Active, not recruiting
• Phase: N/A
• First received: June 2, 2011
• Last updated: March 5, 2018
• Start date: May 2011
• Est. completion date: December 2020

Study information

• Verified date: March 2018
• Source: XVIVO Perfusion
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Human donor lungs that do not meet the standard clinical criteria for donor lung utilization but fit into the study inclusion criteria will be retrieved from the donor using current donor lung retrieval techniques.

Description:

These lungs will be brought to the study transplant center to be re-assessed by the transplant team. The lungs will be physiologically assessed during ex vivo perfusion with Steen Solution. Perfusion of these lungs will be performed using Steen solution with the addition of methylprednisolone, heparin and antibiotics. With respect to the decision of lung utilization those organs with a delta pO2 (Δ pO2 = Pulmonary vein pO2 - pulmonary artery pO2) during ex vivo perfusion assessment > 350mmHg, good lung compliance, and a favorable opinion of the transplant surgeon will be considered transplantable. Lungs will be excluded for transplantation: if the Δ pO2 is less than 350mmHg or if they demonstrate >10% deterioration in any of the following functional parameters: pulmonary vascular resistance (PVR), dynamic compliance or airway pressures. Lungs will also be excluded if they are deemed unsuitable based on the clinical judgment of the lung transplant surgeon.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 252
• Est. completion date: December 2020
• Est. primary completion date: December 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Recipient Inclusion/Exclusion Criteria The recipient inclusion/exclusion criteria apply to patients enrolled in the control or EVLP treatment arms.

1. Recipient Inclusion Criteria

1. Requires single or bilateral lung transplant.

2. Male or Female, 18 years of age or older.

3. Subject or Subject's Representative provides a legally effective informed consent.

2. Recipient exclusion Criteria

1. A recipient is HIV positive.

2. A recipient has active Hepatitis.

3. Investigator believes that the recipient has infection that excludes them from transplant in the study.

4. To receive multi-organ transplant.

5. Is on hemodialysis or has chronic severe renal dysfunction. Severe renal dysfunction is defined as a glomerular filtration rate of 29 or less (mL/min/1.73m2).

6. Is to have planned concurrent cardiac procedures.

7. A recipient is a re-transplant. (A re-transplant is defined as a recipient having the removal and transplant of a previously transplanted lung. A recipient with a previously single lung transplant is eligible to enroll in the trial if it is for the other lung and within 6 months of previous transplant.)

8. A recipient is on Nova Lung, ECMO, or on mechanical ventilation. (CPAP and BIPAP are not exclusionary)

Donor Inclusion/Exclusion Criteria for EVLP Assessment

1. Donor Inclusion Criteria

1. The Donor lung must meet the following criteria to proceed with EVLP:

2. At the time of the clinical evaluation , the PaO2/FiO2 = 300mmHg Or If PaO2/FiO2 > 30mmHg and the donor has any one or more of the following donor risk factors:

• Multiple blood transfusions.

• Pulmonary edema detected via CXR, bronchoscopy or palpation of lungs.

• Donation after circulatory death donors.

• Investigator evaluation of donor lung as "unsuitable" for standard criteria for lung transplant. List reason for "unsuitable" determination.

2. Donor Exclusion Criteria

1. Lung has significant pneumonia and/or persistent purulent secretions on bronchoscopy as determined by investigator.

2. Donor has known significant aspiration of gastric contents within the lung.

3. Donor lung has significant mechanical lung injury or trauma determined by chest x-ray, bronchoscopy, CT Scan or visual inspection.

4. Donor lung has active infectious disease such as HIV, Hepatitis B or C, HTLV or Syphilis. Note: This information is not available at the start of EVLP. Therefore this criteria can be assessed during or post EVLP, but prior to transplant.

Donor Inclusion/Exclusion Criteria for Transplant Suitability after EVLP

1. Donor Inclusion Criteria for Transplant Suitability

1. Surgeon must be clinically satisfied with the lung evaluation (i.e.) overall improvement, if not, the reason for refusal must be listed.

2. Stability or improvement of other lung function parameters during EVLP perfusion

• PVR, Compliance, Airway Pressures.

3. Two delta PO2 greater than 350 mmHg, if two delta PO2 mm Hg are not met than three out of four of the following parameters must be present:

• One delta PO2 of > 350 or absolute PO2 of > 400.

• Chest x-ray findings with absence or improvement of pulmonary edema/infiltrates

• Compliance static (greater than 35 single and greater than 60 for a double)

• Absence of consolidation by palpation

2. Donor Exclusion Criteria for Transplant Suitability after EVLP

1. All delta PO2 (s) are less than 350 mmHg (measured with a FiO2 set at 1.0) or all absolute PO2s are less than 400.

2. Overall greater than 10-15% Functional deterioration of other lung function across all parameters (PVR, Compliance, PawP) with chest x-ray findings showing deterioration.

3. Donor lung positive for infectious diseases such as HIV, Hepatitis B or C, or Syphilis.

Note: This information is not available until at the start of EVLP. Therefore this criteria can be assessed during or post EVLP, but prior to transplant.

Related Conditions & MeSH terms

• Lung Transplant

Intervention

Device:
• XPS™ with Steen Solution™
The XPS™ System is an integrated cardiac bypass system comprised of various components such as a Maquet CardioHelp centrifugal pump (K102726), the HicoVariotherm Heater/Cooler, the Hamilton C2 ICU (intensive care unit) pressure- controlled ventilator (K092148), the perfusate gas monitors, and the display monitors. The XPS™ System is responsible for housing the organ for preservation, providing the normothermic environment, and perfusing the organ with the STEEN Solution™. Donor lungs that meet inclusion criteria are placed on the XPS™ and rewarmed and perfused with STEEN Solution™ and ventilated for 3-6 hours. If the lungs meet transplant suitability, they are cooled down and transplanted into a consented recipient that meet's trial criteria.

Locations

Country	Name	City	State
United States	University of Michigan	Ann Arbor	Michigan
United States	University of Colorado	Aurora	Colorado
United States	University of Maryland	Baltimore	Maryland
United States	Brigham and Women's Hospital	Boston	Massachusetts
United States	University of Chicago	Chicago	Illinois
United States	Ohio State University	Columbus	Ohio
United States	University of Texas Southwestern	Dallas	Texas
United States	Henry Ford	Detroit	Michigan
United States	Duke University	Durham	North Carolina
United States	University of Florida-Gainesville	Gainesville	Florida
United States	Indiana University Health	Indianapolis	Indiana
United States	Cedars-Sinai Medical Center	Los Angeles	California
United States	Columbia University Medical Centre	New York	New York
United States	University of Pennsylvania	Philadelphia	Pennsylvania
United States	University of Pittsburgh	Pittsburgh	Pennsylvania
United States	Barnes Jewish Hospital	Saint Louis	Missouri
United States	University of Washington Medical Center	Seattle	Washington
United States	Tampa General Hospital	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
XVIVO Perfusion

Country where clinical trial is conducted

United States, 

References & Publications (29)

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Cypel M, Rubacha M, Yeung J, Hirayama S, Torbicki K, Madonik M, Fischer S, Hwang D, Pierre A, Waddell TK, de Perrot M, Liu M, Keshavjee S. Normothermic ex vivo perfusion prevents lung injury compared to extended cold preservation for transplantation. Am J Transplant. 2009 Oct;9(10):2262-9. doi: 10.1111/j.1600-6143.2009.02775.x. Epub 2009 Aug 6. — View Citation

Cypel M, Sato M, Yildirim E, Karolak W, Chen F, Yeung J, Boasquevisque C, Leist V, Singer LG, Yasufuku K, Deperrot M, Waddell TK, Keshavjee S, Pierre A. Initial experience with lung donation after cardiocirculatory death in Canada. J Heart Lung Transplant. 2009 Aug;28(8):753-8. doi: 10.1016/j.healun.2009.05.009. Epub 2009 Jun 28. — View Citation

Cypel M, Yeung JC, Hirayama S, Rubacha M, Fischer S, Anraku M, Sato M, Harwood S, Pierre A, Waddell TK, de Perrot M, Liu M, Keshavjee S. Technique for prolonged normothermic ex vivo lung perfusion. J Heart Lung Transplant. 2008 Dec;27(12):1319-25. doi: 10.1016/j.healun.2008.09.003. — View Citation

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Fisher AJ, Donnelly SC, Hirani N, Haslett C, Strieter RM, Dark JH, Corris PA. Elevated levels of interleukin-8 in donor lungs is associated with early graft failure after lung transplantation. Am J Respir Crit Care Med. 2001 Jan;163(1):259-65. — View Citation

Inci I, Ampollini L, Arni S, Jungraithmayr W, Inci D, Hillinger S, Leskosek B, Vogt P, Weder W. Ex vivo reconditioning of marginal donor lungs injured by acid aspiration. J Heart Lung Transplant. 2008 Nov;27(11):1229-36. doi: 10.1016/j.healun.2008.07.027. Epub 2008 Oct 1. — View Citation

Ingemansson R, Eyjolfsson A, Mared L, Pierre L, Algotsson L, Ekmehag B, Gustafsson R, Johnsson P, Koul B, Lindstedt S, Lührs C, Sjöberg T, Steen S. Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo. Ann Thorac Surg. 2009 Jan;87(1):255-60. doi: 10.1016/j.athoracsur.2008.09.049. — View Citation

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* Note: There are 29 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	PAS Study Primary Endpoint	The primary end point is a co-primary endpoint comparing survival rates and rates of grade 3 PGD at 72 hours with success if and only if both endpoints are met.; Treatment Group (T) = EVLP transplant subjects Control Group (C) = standard transplant subjects; Co-Primary Endpoints: Endpoint #1: Survival of T is non-inferior to C Ho: C - T = M1 (T is inferior to the control by M1 or more) Ha: C - T < M1 (T is inferior to the control by less than M1) where M1 = 0.12 Endpoint #2: Rate of grade 3 PGD at 72 hours for T is non-inferior to the rate for C Ho: C - T = M2 Ha: C - T < M2 where M2 = 0.12	3 Years
Primary	PMA Study Primary Endpoint	The primary end point is non-inferiority of the 3-year survival rate of the EVLP group as compared to 3-year survival rate of the control group.; Ho: C - T = M3 (T is inferior to the control by M3 or more) Ha: C - T < M3 (T is inferior to the control by less than M3) where M3 = 0.12	72hrs and Survival
Secondary	PMA Secondary Endpoints	Primary Lung Graft Dysfunction (PGD) is an indicator for significant morbidity The PMA secondary endpoints are as follows: FEV1 at 3 mos, 6 mos, 9 mos, and 1 yr; PGD score at 24 and 48 hrs; ICU LOS; Hospital LOS; Use of ECMO due to lung function post transplant; Duration of mechanical ventilation post transplant; Quality of Life and functional status at one year	3 Years
Secondary	PAS Secondary Endpoint:	Quality of Life measured by functional status, physical capability, and employment limitations.; Episodes of rejection per UNOS registry; FEV1 at 1, 2, 3, 4, and 5 years	5 Years