Early pulmonary function and mid-term outcome in lung transplantation after ex-vivo lung perfusion - a single-center, retrospective, observational, cohort study.

Abstract

Outcomes after transplantation of lungs (LuTX) treated with ex-vivo lung perfusion (EVLP) are debated. In a single-center 8years of retrospective analysis, we compared: donors' and recipients' characteristics, gas exchange and lung mechanics at ICU admission, 3, 6, and 12months, and patients' survival of LuTX from standard donors compared with EVLP-treated grafts. A total of 193 LuTX were performed. Thirty-one LuTX, out of 50 EVLP procedures, were carried out: 7 from nonheart beating and 24 from extended criteria brain-dead donors. Recipients' characteristics were similar. At ICU admission, compared with standard donors, EVLP patients had worse PaO2 /FiO2 [276 (206; 374) vs. 204 (133; 245) mmHg, P<0.05], more frequent extracorporeal support (18% vs. 32%, P=0.053) and longer mechanical ventilation duration [28days of ventilator-free days: 27 (24; 28) vs. 26 (19; 27), P<0.05]. ICU length of stay [4 (2; 9) vs. 6 (3; 12) days, P=0.208], 28-day survival (99% vs. 97%, P=0.735), and 1-year respiratory function were similar between groups. Log-rank analysis (median follow-up 2.5years) demonstrated similar patients' survival (P=0.439) and time free of chronic lung allograft disease (P=0.484). The EVLP program increased by 16% the number of LuTX. Compared to standard donors, EVLP patients had worse respiratory function immediately after LuTX but similar early and mid-term outcomes.