Characteristics and outcomes of lung transplants performed with ex-situ lung perfusion

Abstract

Ex-situ lung perfusion (ESLP) can be used to assess and rehabilitate donor lungs, potentially expanding the donor pool. We examined the characteristics and outcomes of lung transplants performed with ESLP in the United States. Retrospective review of the United Network for Organ Sharing (UNOS) registry of primary adult lung transplant recipients from February 28, 2018 to June 30, 2021 was performed, comparing baseline characteristics, in-hospital outcomes, and one-year survival of ESLP versus no ESLP lung transplants. Of 8,204 lung transplants, 426(5.2%) were performed with ESLP. ESLP donors were older, more donation after circulatory death (DCD), and had lower P:F ratios. Recipients had lower lung allocation scores. ESLP lungs traveled further, had longer preservation times, and were more likely double lung transplants. Reintubation rates, ECMO at 72 hours, and hospital length of stay were greater in the ESLP group. On multivariable analysis, ESLP was not an independent predictor of one-year survival. However, further analysis showed that DCD lungs managed on ESLP had worse 1-year survival compared to DCD lungs preserved with standard cold storage or with donation after brain death donor lungs. ESLP is used in a small percentage of lung transplants in the US and is not independently associated with one-year survival. ESLP combined with DCD lungs, however, is associated with worse one-year survival and warrants further investigation.