Long-term Outcomes of Lung Transplant With Ex Vivo Lung Perfusion

Divithotawela C¹, Cypel M¹, Martinu T  Singer LG¹, Binnie M¹, Chow CW¹, Chaparro C¹, Waddell TK¹, de Perrot M¹, Pierre A¹, Yasufuku K¹, Yeung JC¹, Donahoe L¹, Keshavjee S¹, Tikkanen JM¹.  (Toronto)                      

JAMA Surg. 2019 Oct 9. doi: 10.1001/jamasurg.2019.4079. [Epub ahead of print]           

IMPORTANCE:
The mortality rate for individuals on the wait list for lung transplant is 15% to 25%, and still only 20% of lungs from multiorgan donors are used for lung transplant. The lung donor pool may be increased by assessing and reconditioning high-risk extended criteria donor lungs with ex vivo lung perfusion (EVLP), with similar short-term outcomes.

OBJECTIVE: 
To assess the long-term outcomes of transplant recipients of donor lungs treated with EVLP. 

Design, Setting, and Participants:  This retrospective cohort single-center study was conducted from August 1, 2008, to February 28, 2017, among 706 recipients of donor lungs not undergoing EVLP and 230 recipients of donor lungs undergoing EVLP.

EXPOSURE:
Donor lungs undergoing EVLP.

MAIN OUTCOMES AND MEASURES:
The incidence of chronic lung allograft dysfunction and allograft survival during the 10-year EVLP era were the primary outcome measures. Secondary outcomes included donor characteristics, maximum predicted percentage of forced expiratory volume in 1 second, acute cellular rejection, and de novo donor-specific antibody development.

RESULTS:
This study included 706 patients (311 women and 395 men; median age, 50 years [interquartile range, 34-61 years]) in the non-EVLP group and 230 patients (85 women and 145 men; median age, 46 years [interquartile range, 32-55 years]) in the EVLP group. The EVLP group donors had a significantly lower mean (SD) Pao2:fraction of inspired oxygen ratio than the non-EVLP group donors (348 [108] vs 422 [88] mm Hg; P < .001), higher prevalence of abnormal chest radiography results (135 of 230 [58.7%] vs 349 of 706 [49.4%]; P = .02), and higher proportion of smoking history (125 of 204 [61.3%] vs 322 of 650 [49.5%]; P = .007). More recipients in the EVLP group received single-lung transplants (62 of 230 [27.0%] vs 100 of 706 [14.2%]; P < .001). There was no significant difference in time to chronic lung allograft dysfunction between the EVLP and non-EVLP group (70% vs 72% at 3 years; 56% vs 56% at 5 years; and 53% vs 36% at 9 years; log-rank P = .68) or allograft survival between the EVLP and non-EVLP groups (73% vs 72% at 3 years; 62% vs 58% at 5 years; and 50% vs 44% at 9 years; log-rank P = .97) between the 2 groups. All secondary outcomes were similar between the 2 groups.

CONCLUSIONS:
Since 2008, 230 of 936 lung transplants (24.6%) in the Toronto Lung Transplant Program were performed after EVLP assessment and treatment. Use of EVLP-treated lungs led to an increase in the number of patients undergoing transplantation, with comparable long-term outcomes.

PMID: 31596484
PMCID: PMC6802423 [Available on 2020-10-09]
DOI: 10.1001/jamasurg.2019.4079