Single‐center experience of <i>ex vivo</i> lung perfusion and subsequent lung transplantation

BackgroundThe purpose of this study was to identify the association of increasing ischemic times in recipients who receive lungs evaluated by ex vivo lung perfusion (EVLP) and their association with outcomes following lung transplantation.MethodsLung transplant recipients who received an allograft evaluated by EVLP were identified from the United Network for Organ Sharing (UNOS) Database from 2016–2023. Recipients were stratified into three groups based on total ischemic time (TOT): short TOT (STOT, 0 to <7 h), medium TOT (MTOT, 7> to <14 h), and long TOT (LTOT, +14 h). The groups were assessed with comparative statistics and Kaplan–Meier methods. A Cox regression was created to determine the association of ischemic time in EVLP donors and long‐term mortality.ResultsRecipients in the LTOT group had significantly longer length of stay and post‐operative extracorporeal membrane use at 72 h (p < 0.05 for both). Additionally, they had nonsignificant increases in rate of stroke (4.7%, p = 0.05) and primary graft dysfunction grade 3 (PGD3, 27.5%, p = 0.082). However, there was no significant difference in hospital mortality or mid‐term survival (p > 0.05 for both). On multivariable analysis, ischemic time was not associated with increased mortality whereas increasing recipient age, preoperative ECMO use and donation after circulatory death donors were (p < 0.05 for all).ConclusionsIf EVLP technology is available, under certain circumstances, surgeons should not be dissuaded from using an allograft with extended ischemic time.

show abstract

Long-term survival and development of chronic graft dysfunction after donor lung perfusion repair in isolated lungs-a meta-analysis

Wang,

Zhang,

et al. 2023

Preprint

View full text Add to dashboard Cite

Background EVLP is deemed successful in enhancing the pool of candidates for lung transplantation subject to a reevaluation of the donor lung’s physiological and biological performance, in addition to an increased preservation period, and aids in healing damaged lung. This meta-analysis aimed to evaluate the impact of EVLP on long-term patient outcomes compared to conventional lung transplantation. Methods The data about conventional lung transplantation without ELVP and lung transplantation with EVLP repair were collected. The data were subjected to analysis like receptor baseline values and surgical outcomes, while OR, MD, and HR were employed as effect sizes. Results Among the collected literature, ten publications were deemed qualified for incorporation into the study, comprising one prospective cohort and nine retrospective cohort studies, with 5471 donors and 5464 receivers. Those subjects with marginal donor lungs examined and treated with EVLP exhibited equivalent overall and CLAD-free survival compared to those with conventional donor lungs. Moreover, donors in the EVLP group had higher chest X-ray abnormalities and lower P/F. The two groups had no significant difference in developing grade 3 PGD3 post 72 hours of surgery, but the EVLP group required a more extended ICU stay. Other postoperative results for the two groups were comparable. Conclusions The donor lung’s quality was lower in the ELVP group; however, those with donor lung EVLP screening and therapy had comparable overall and CLAD-free survival to those who underwent conventional donor lung.

show abstract

Single‐center experience of ex vivo lung perfusion and subsequent lung transplantation

Cited by 4 publications

References 52 publications

Airway Complications of Lung Transplantation

Airway Complications of Lung Transplantation

Extended ischemic times during ex vivo lung perfusion is not associated with increased mortality

Long-term survival and development of chronic graft dysfunction after donor lung perfusion repair in isolated lungs-a meta-analysis

Contact Info

Product

Resources

About