New multicenter clinical data suggests caution when extending cold preservation after warm EVLP

A recent US multicenter clinical trial⁽¹⁾ seems to confirm previous interim findings that the duration of the second cold lung preservation phase after warm ex-vivo lung perfusion (EVLP), just prior to implanting the lung, should preferably not exceed five hours.

When this second phase of cold ischemia exceeded five hours, both primary graft dysfunction (PGD) at 72 hours and one-year survival clearly deteriorated (PGD: p = 0.004 and for one-year survival: p = 0.001). Cold pre-EVLP ischemic time, however, was not a significant predictor of primary outcomes.

These clinical findings, based on 110 EVLP treated lungs from 17 US lung centers, would seem more cautious than the corresponding findings of a fairly tough experimental study on pig lungs published by the Toronto group⁽²⁾ in 2016. This later experimental study suggested that a second cold preservation time after warm EVLP could be safely extended to 10 hours, at least based on outcomes over the first four post-implant hours. But it is clear from both studies that a period of EVLP strikingly increases acceptable total ischemic time.

References:

1. Leiva-Juárez MM, et al. Extended post-ex vivo lung perfusion cold preservation predicts primary graft dysfunction and mortality: Results from a multicentric study. J Heart Lung Transplant. 2020 May 16:S1053-2498(20)31554-0 (link to abstract)

2. Hsin MKY et al, Extension of Donor Lung Preservation With Hypothermic Storage After Normothermic Ex Vivo Lung Perfusion. J Heart Lung Transplant. 2016 Jan; 35(1):130-136 (link to abstract)

Xvivo Insights PB-2020-06-31