8. Ex-vivo Lung Perfusion - 10 Year Follow-up of the First Performed Double LTX With Marginal Donor Lungs Evaluated Using EVLP
Fakhro M, Andreasson J, Pierre L, Ingemansson R, Lindstedt S, J Heart Lung Transplant. 37, 45, April 2018, Suppl S149.
In 2006 and 2007 we did the first double LTx in the world using marginal donor lungs evaluated ex vivo using ex vivo lung perfusion (EVLP) developed by Professor Stig Steen. Here we present a 10 year follow up comparing EVLP lungs with the conventional lungs performed at our clinic in the same year.
Between 2006-2007, 21 patients (6 EVLP; 15 conventional) underwent LTx with follow-up until May 2016 at Lund University Hospital, Sweden. Pulmonary function was measured with spirometry and 6-minute walking test (6MWT) at 3, 6, 12 months and annually. Kaplan-Meier and Cox regression analyses was used to assess survival with death/re-lung transplantation as end-point.
No difference in median age nor gender distribution was shown between EVLP vs. conventional-LTx (p>0.05). Forced expiratory volume in 1 sec (FEV1) and 6MWT in 3, 6, 12 months and annually until 10-years is shown in image 1. No difference in median FEV1 nor 6MWT was found for EVLP vs. conventional-LTx (p>0.05). Survival curves for EVLP vs. conventional LTx for patients with a limited survival up to 5-years and overall survival up to 10-years respectively is shown (image 1). No significance was found (p>0.05). Same pattern was shown in subanalyses for patients with a limited survival up to 1-year and corresponding Cox regression analyses for 1-, 5- and 10-years (p>0.05).
No superiority was found in conventional-LTx over EVLP LTx, neither in long-term survival nor pulmonary function. EVLP is a safe and effective method to use in LTx. EVLP has revalonated LTx and made it possible to improve marginal lungs but also to evaluate lungs post-mortem.