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Background: Even in the extended-criteria era, the reasons for declining lung donors are not always clear. Furthermore, it has not been determined how many actual declined lungs would be retrieved by ex vivo lung perfusion (EVLP) beyond that already achieved in centers with an existing high utilization rate., Methods: This retrospective study reviewed all lung donor referrals between 2014 and 2018, including detailed formal referrals and preliminary notifications. This study categorized reasons for lung donor non-acceptance and estimated how many declined grafts could have been theoretically retrievable by using EVLP., Results: In total, 966 lung donor candidates were referred, including 313 transplanted donors, 336 declined donors after detailed referrals (group A) and 258 preliminary declined. In group A, the primary reasons for refusal were lung quality issues (49%), general medical issues (25%), and organization issues (26%), combined with secondary reasons in many cases. Main lung quality issues were an extensive smoking history, abnormal chest radiography, and underlying lung disease. Although 73 declined lung donors had indications for EVLP, the retrievable lungs decreased to only 30 cases after considering the details of all clinical contraindications and organizational issues. Nevertheless, 59 intended donation after circulatory death donors did not progress to death after withdrawal of cardiorespiratory support in the required timeframe, and EVLP may have an emerging additional role here., Conclusions: Based on commonly cited criteria for EVLP indication, the number of EVLP retrievable lung donors represented only a small portion of declined donor lungs referred to our center from the state donation network., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Although it is intense in health care resources, by facilitating assessment and reconditioning, ex vivo lung perfusion (EVLP) has the potential to expand the donor pool and improve lung transplant outcomes. However, inclusion criteria used in EVLP trials have not been validated., Methods: This retrospective study from 2014 to 2018 reviewed our local state-based donation organization donor records as well as subsequent recipient outcomes to explore the relation between EVLP indications used in clinical trials and recipient outcomes. The primary outcome was primary graft dysfunction grade 3 at 24 hours, with 30-day mortality and posttransplant survival time as secondary outcomes, compared with univariate and multivariate analysis., Results: From 705 lung donor referrals, 304 lung transplantations were performed (use rate of 42%); 212 of recipients (70%) met at least 1 of the commonly cited EVLP initiation criteria. There was no significant difference in primary graft dysfunction grade 3 or 30-day mortality between recipients with or without an EVLP indication (10.2% versus 7.8%, P = .51; and 2.4% versus 0%, P = .14, respectively). Multivariate analyses showed no significant relationship between commonly cited EVLP criteria and primary graft dysfunction grade 3 or survival time. Recipient outcomes were significantly associated with recipient diagnosis., Conclusions: At least 1 commonly cited criterion for EVLP initiation was present in 70% of the transplanted donors, and yet it did not predict clinical results; acceptable outcomes were seen in both subgroups. To discover the true utility of EVLP beyond good clinical management and focus EVLP on otherwise unacceptable lungs, a reconsideration of EVLP inclusion criteria is required., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Ex-vivo lung perfusion (EVLP) is a complex, expensive assessment tool suggested to predict successful early graft function and therefore which 'extended' lungs should be used. Theoretic 'graft at-risk' criteria for EVLP initiation used in EVLP trials include: donor age >55yrs, PaO 2 /F I O 2 (PF) <300, abnormal chest X ray, aspiration, >10 unit transfusion, DCD, expected graft ischemia time (GIT) >6hrs. Our centre routinely uses extended donor lungs without EVLP. DonateLife records and clinical databases were combined, with univariate and multivariate analyses undertaken to clarify the relation between EVLP initiation criteria and lung-transplant (LTx) outcomes. 304 LTx were performed 2014 to 2018 from 704 donor referrals (=42% conversion rate, =11.3 LTx per million population, cf US = 7.0 LTx PMP). 69% of LTx performed had >1 criteria for EVLP assessment (25% = 2, 5.2% = >3 criteria). Table 1 outlines the incidence and effect of these criteria. A PF <300 and GIT >6hrs had small effects on outcomes <90dys. Multivariate analyses noted no donor criteria association with PGD3. Mechanical ventilation hours are associated with type of LTx and recipient's diagnosis (Table 2). At least 1 recommended criteria for EVLP initiation was present in the majority of our LTx. These did not predict early outcomes- with very acceptable results seen in all subgroups. However, the relevance of combination or extreme criteria in lungs not used is unknown. Based on this study, the true utility of EVLP to enhance LTx acceptability and success rates, beyond good clinical management alone, requires an RCT. [ABSTRACT FROM AUTHOR]