Long term clinical outcomes after EVLP

Long term clinical outcomes after ex-vivo perfusion of previously rejected lungs are comparable with outcomes from ‘standard lungs’.

The use of ex-vivo lung perfusion (EVLP) to re-assess and recondition sub-standard (previously rejected) lungs before transplantation is a rapidly expanding new procedure. However, few centers to date have yet accumulated sufficient follow-up data to confidently compare mid- to long-term (> 5 years) clinical outcomes after EVLP-lung transplants with outcomes after transplantation of standard non-EVLP lungs.

Toronto findings

Possibly the only truly “long-term” experience (now >7 years) is from Toronto (Tikkanen et al * (1)) who as early as 2014 reported that short- to long-term functional outcomes, rejection rates and mortality among recipients of 64 previously rejected EVLP lungs were quite comparable with those of conventional standard lungs.

Confirming the Toronto findings

Reassuring confirmation of these findings is now trickling in from other centers, most recently from the Swedish Gothenburg group (Wallinder et al, 2016 (2)) who have followed recipients of 27 EVLP lungs for up to 4 years. Their mid-term results are impressive and reassuring – no statistical differences were found in early- or mid-term lung function, rejection or survival rates between the EVLP treated lungs and standard “acceptable” lungs that were not subjected to EVLP.

Primary graft dysfunction (PGD), grades 1-3 at 72 hours post-transplant, for example, was 14% in the EVLP group and 12% in the non-EVLP group. (n.s.) Survival at 1 year was actually higher in the EVLP group (92%) than in the non-EVLP group (79%) but this difference was not statistically significant.

Also of interest was the high 88% EVLP conversion rate (the proportion of EVLP- treated marginal lungs which were reassessed as acceptable after EVLP). This compares well with the 86% rate reported from Toronto. Note however that Toronto´s EVLP data included a number of DCD lungs, which are not always considered sub-standard. Conversion rates of course also depend on the inclusion criteria for EVLP and the experience of the transplantation team.

1. Tikkanen et al, 2015. Functional outcomes and quality of life after normothermic ex vivo lung perfusion lung transplantation. (Link to abstract)
2. Wallinder et al, 2016. Transplantation after ex vivo lung perfusion: A mid-term follow-up. (Link to abstract)

XVIVO Insights. PB-2017-03-16