Shaf Keshavjee

In 1985, Dr Keshavjee completed his medical degree at the University of Toronto.[3] He did a comprehensive surgical internship at the Mount Sinai Hospital in 1986. His Research Fellowship and Surgical Scientist Program in the Division of Thoracic Surgery were done at the University of Toronto and Toronto General Hospital in 1989. That same year he received his MSc in the Institute of Medical Science at the University of Toronto. A few years later in 1993, Dr. Keshavjee became a Fellow in Thoracic Surgery at the Memorial Sloan-Kettering Cancer Centre in New York. In 2012 he went to Harvard University, JFK School of Government and Cambridge to obtain a degree in continuing education for Leadership for the 21st Century: Chaos, Conflict and Courage. In 1994, he joined the faculty at the University of Toronto.[4]

• 1994–Present: Director of Thoracic Surgery Research Laboratory, Toronto General Research Institute (TGRI) and University of Toronto (U of T)[5]
• 1995–Present: Faculty in the Institute of Medical Sciences, School of Graduate Studies at the University of Toronto[6]
• 1997–Present: Senior Scientist, Division of Experimental Therapeutics, UHN, TGRI[7]
• 1997–Present: Director, Toronto Lung Transplant Program, Toronto General Hospital (TGH) and The Hospital for Sick Children[8]
• 2002–Present: Professor of Surgery, Department of Surgery, U of T[9]
• 2010–Present: Surgeon-in-Chief, Sprott Department of Surgery, UHN[10]
• 2012–Present: Adjunct Scientist, Hospital for Sick Children Research Institute[11]

At his Thoracic Surgery Research Laboratory, Dr. Kehavjee's research interests include lung transplantation, lung injury, and lung preservation. His current studies examine molecular diagnostics and gene therapy strategies for engineering organs for lung transplantation. The Lab's work explores the underlying mechanisms of ischemia-reperfusion injury and bronchiolitis obliterans – two areas that limit successful lung transplantation – and develops gene therapy strategies for either preventing or reversing them. Several areas within ischemia-reperfusion injury are examined, including the role of complement and cytokine-related lung injury and its relation to reperfusion. The work is done on cell culture models, rat single lung transplant models, and pig single lung transplant models.[17]

Dr. Keshavjee currently serves as the Director of the Toronto Lung Transplant Program, a University of Toronto program that spans across UHN and the Hospital for Sick Children. It began in 1983, and expanded to pediatric lung transplantation surgeries in 1995. Located in the Toronto General Hospital, it has gained international recognition for performing several remarkable firsts, including: First successful single-lung transplant, first successful double lung transplant, first pediatric lung transplant, first pediatric lung transplant with mismatched blood types, first to use an EXVIVO outside of the body, and the first to use the Novalung ventilator to provide more time for those awaiting transplantation.[20] The TLTP uses 40% of the donated lungs it receives, compared to 15% of donated lungs used elsewhere in the world.

As a result of Dr. Keshavjee's breakthroughs, there have been steady increases in the number of transplants and the survival rate. While the one-year survival rate for lung transplant recipients is 85% and almost 30% for over 10 years, the TLTP has 22 patients who have survived 20 or more years after receiving their donor lungs.[21]

A gene-therapy trial will begin next year.[22]

Dr. Keshavjee was internationally recognized for his leadership in the development of the Toronto Ex Vivo Lung Perfusion System, which treats and improves high-risk donor lungs outside of a human body so that they can be safely used for transplantation.

Donor lungs are placed in ice, with one tube attached to the pulmonary artery and another sewn to a vein used for training blood out of the lung. The lung is then moved onto a steel platform atop the device and hooked to a circuit with a ventilator and heart-lung mimicking machine that pumps the preservation solution into them. As they are brought up to body temperature, they are healed with an anti-inflammatory solution (developed by Dr. Keshavjee). Eventually, the lungs begin to inflate and deflate as they breathe on their own. For several hours, the lungs are monitored for functionality with blood gases, x-rays, bronchoscopies, resistance to the flow of fluid, and whether they are becoming less stiff. If the tests are deemed successful for function, they may go ahead and perform the transplantation.[23]