4. Post EVLP Cold Preservation Period Is Associated With Clinical Outcomes
Arango -Tomas et al. J Heart Lung Transplant. April 2015 Vol 34, Issue 4, Supplement, Pages S96–S97,
E. Arango Tomas. P. Sanchez, R.D. Davis, E. Cantu, M.J. Weyant, D. Lederer, P.C. Camp, B.P. Griffith, F. D’Ovidio
Ex vivo lung perfusion (EVLP) is changing the lung preservation paradigm. Standard cold preservation is followed by normothermic EVLP, then lungs undergo a second cold preservation prior to implantation. We recently demonstrated that high-risk lungs re-assessed by EVLP have similar outcomes to standard criteria lungs. Nevertheless a paucity of data exist on how the sequence of cold-normothermic-cold preservations affect outcomes. We investigated the effects of preservation times in transplanted EVLP lungs.
Data from the NOVEL trial was retrospectively analyzed. Duration of the 3 preservation phases was measured: cold pre EVLP; EVLP; cold post EVLP. Donor & recipient clinical data were collected. Primary graft dysfunction (PGD) and 1-year mortality were monitored.
Complete data was obtained on 42 patients transplanted post EVLP. At 72 hours PGD 2 was present in 5/42 (12%) and PGD3 in 4/42 (9%). One-year mortality was 6/42 (16%). Using a 75th percentile cut-off time a cold post EVLP time ≥ 322min was considered Extended. ROC method confirmed cut-off for accuracy towards PGD or 1-year mortality. Logistic regression analysis for Extended cold post-EVLP preservation and PGD (2 or 3) at 72 hours showed OR 11.2 (95%CI 2.1-60.2) p<0.005, and when adjusted for normothermic EVLP time OR=9 (95% CI 1.4-46.8) p=0.02. Cox proportional analysis for 1-year survival showed HR 15 (95%CI 1.7-129) p=0.01, and when adjusted for EVLP time HR 18 (95% 1.9-176) p=0.01. Tables show the Chi square analysis (Fisher’s test p<0.05). No association was noted with the cold pre EVLP preservation. Conclusion Cold preservation post EVLP seems to adversely impact on clinical outcomes. In particular, extended (>5hrs) duration of cold post EVLP preservation times associated with a significantly greater risk for PGD and one-year mortality. These preliminary findings from a small cohort of patients in a multicenter trial need to be confirmed in a larger cohort, although should caution on the implementation of extended duration of cold preservation post EVLP.