PURPOSE: Ex vivo lung perfusion (EVLP) is a technology to evaluate marginal lungs or to preserve standard lungs for logistical reasons. However, the recovery rate for the various indications for EVLP is unknown. The aim of this study is to examine the recovery rate when EVLP is performed for various indications and to evaluate outcomes following transplantation. METHODS: From Feb 2016 to Sep 2019, 441 lung transplants were performed. During this time, 61 pairs of lungs were perfused using the Toronto-EVLP protocol with intent to transplant. EVLP was broadly utilized for 1) Concerns with lung quality or 2) Logistical restrictions with the transplant. Donation after cardiac death (DCD) lungs were perfused when PaO2/FiO2 (P/F) ratio was less than 300 mmHg or agonal time was 60-120 min. Recovery rate was defined as EVLP cases with lung transplant/ all EVLP cases. Post-operative outcomes of EVLP group were compared to those of recipients receiving lungs meeting standard criteria. RESULTS: In the EVLP obtained organs, donor age was median 35 (Interquartile range 26-45) years with 50.8% of lungs from DCD. P/F ratio in intensive care unit was 329 (259-391) mmHg. The indications for EVLP included most commonly a low PF ratio <300 mmHg prior to procurement (44%), logistical reasons (23%), prolonged agonal time >60 min (18%), the presence of edematous lungs (14%) and question of contusion or pulmonary embolism/infarction (13%). Of the 61 perfused lungs, 39 lungs were clinically utilized in 40 lung transplants (recovery rate = 39/61, 63.9%). The recovery rate varied by indication for EVLP with the highest rate occurring when logistics were the reason for EVLP (92%); followed by extended agonal time >60 min (90%), and then when the extent of contusion or pulmonary embolism was in question (62%). Lower recovery rates from EVLP were found when EVLP was used for P/F ratio <300 mmHg (55%) and when the lungs were edematous (25%); Post transplant, primary graft dysfunction Grade 3 was present in 4 cases (10%) at 72 hours. There was no significant difference in survival between EVLP and control groups (30 days, 100 vs. 97%, p = 0.60; 1 year, 92 vs. 88%, p = 0.60). CONCLUSION: These data demonstrate that EVLP for marginal or logistical indications can result in a recovery rate of 63% with comparable outcomes to transplants with standard lungs. The data also suggest that the indication for EVLP is an important factor in the recovery rate.
|Journal||The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation|
|Publication status||Published - 2020 Apr 1|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine