Commonly Used Criteria to Initiate Ex-Vivo Lung Perfusion Have No Significant Impact on Early Post Lung-Transplant Outcomes

Abstract

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, PaO2/FIO2 (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.