1. Functional outcomes and quality of life after normothermic ex vivo lung perfusion lung transplantation

J Heart Lung Transplant. 2015 Apr;34(4):547-56. doi: 10.1016/j.healun.2014.09.044. Epub 2014 Oct 24.
Tikkanen JM1, Cypel M1, Machuca TN1, Azad S1, Binnie M1, Chow CW1, Chaparro C1, Hutcheon M1, Yasufuku K1, de Perrot M1, Pierre AF1, Waddell TK1, Keshavjee S1, Singer LG2. (Toronto)

BACKGROUND:

Ex vivo lung perfusion (EVLP) is an effective method to assess and improve the function of otherwise unacceptable lungs, alleviating the shortage of donor lungs. The early results with EVLP have been encouraging, but longer-term results, including functional and patient-reported outcomes, are not well characterized.

METHODS:

This retrospective single-center study included all lung transplants performed between September 2008 and December 2012. We investigated whether survival or rate of chronic lung allograft dysfunction (CLAD) differed in recipients of EVLP-treated lungs compared with contemporaneous recipients of conventional donor lungs. We also studied functional (highest forced expiratory volume in 1 second predicted, change in 6-minute walk distance, number of acute rejection episodes) and quality of life outcomes.

RESULTS:

Of 403 lung transplants that were performed, 63 patients (15.6%) received EVLP-treated allografts. Allograft survival for EVLP and conventional donor lung recipients was 79% vs 85%, 71% vs 73%, and 58% vs 57% at 1, 3, and 5 years after transplant, respectively (log-rank p = not significant). Freedom from CLAD was also similar (log-rank p = 0.53). There were no significant differences in functional outcomes such as highest forced expiratory volume in 1 second predicted (76.5% ± 23.8% vs 75.8% ± 22.8%, p = 0.85), change in 6-minute walk distance (194 ± 108 meters vs 183 ± 126 meters, p = 0.57), or the number of acute rejection episodes (1.5 ± 1.4 vs 1.3 ± 1.3, p = 0.36). The EVLP and conventional donor groups both reported a significantly improved quality of life after transplantation, but there was no intergroup difference.

CONCLUSION:

EVLP is a safe and effective method of assessing and using high-risk donor lungs before transplantation and leads to acceptable long-term survival, graft function, and improvements of quality of life that are comparable with conventionally selected donor lungs.

Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. KEYWORDS: chronic lung allograft dysfunction; donor selection; ex vivo lung perfusion; lung function; patient-reported outcomes; transplantation PMID: 25476845 DOI: 10.1016/j.healun.2014.09.044