Characteristics and Outcomes of Lung Transplants Performed with Ex-Vivo Lung Perfusion.

Ex-vivo lung perfusion (EVLP) can be used to assess and rehabilitate donor lungs to expand the donor pool. However, the frequency of EVLP utilization and its outcomes are not well-studied. The goal of this study was to describe the characteristics and outcomes of lungs transplants performed with EVLP in the US. We conducted retrospective review of the UNOS registry of all primary adult lung transplant recipients from Feb 28, 2018 to June 30, 2021, excluding recipients with prior transplants, multiorgan transplants, and those waitlisted for other organs. Lung transplants were dichotomized as those that were performed with EVLP versus no EVLP. Baseline characteristics and short-term outcomes were compared. One-year survival was assessed by the Kaplan Meier method and multivariable Cox proportional hazards regression. Of 8,204 lung transplants performed during our study period, 426(5.2%) were performed with EVLP. Perfusion was performed by the OPO in 29(7%), transplant center in 291(68%), and external perfusion center in 106(25%) of cases. EVLP donors were older (39±13 vs 36±14 yrs, p<0.01), more likely DCD (31% vs 5%, p<0.01), and had lower P:F ratio(415±124 vs 442±130, p<0.01). Recipients had lower LAS scores[39(35-53) vs 41 (35-57), p<0.01)]. EVLP lungs traveled further[232(122-489) vs 169 (71-270) nautical miles, p<0.01], had longer ischemic times(11.5±4.1 vs 5.5±1.6 hrs, p<0.01), and were more likely double lung transplants(85% vs 76%, p<0.01). At 72 hours, recipients of EVLP lungs were more likely to remain intubated(47% vs 30%, p<0.01), be on ECMO(16% vs 8%, p<0.01), and experience PGD grade III (24% vs 17%, p<0.01). They also had higher total length of stay[21(13-39) vs 18(13-30) days, p<0.01). EVLP was associated with worse one-year survival on univariable(84% vs 88%, HR 1.41, 95% CI 1.07-1.85, p=0.02) but not multivariable analysis(aHR 1.18, 95% CI 0.88-1.59, p=0.26), particularly after adjusting for DCD donation(aHR 1.46, 95% CI 1.11-1.91) EVLP technology is used in a minority of donor lungs in the United States. A majority of the EVLP procedures are performed by the transplant centers with a higher proportion of DCD donors. The short-term outcomes and one-year survival of recipients of EVLP lungs appear worse than those not managed with EVLP. The role of this technology in the broad filed of lung transplantation remains to be defined. [ABSTRACT FROM AUTHOR]