Ex Vivo Lung Perfusion Resuscitated Donor Lungs and Subsequent Acute Rejection and Airway Complications: A Systematic Review and Meta-Analysis

Abstract

Ex Vivo Lung Perfusion (EVLP) resuscitates donor lungs for use in lung transplant. Acute rejection can occur in more than 30% of all lung transplant recipients and is a risk factor of chronic allograft dysfunction, which is the primary cause of long-term morbidity and mortality in recipients. Airway complications can occur in up to 18% of recipients, with a risk factor being prolonged hypo-perfusion or ischemia to the bronchus. A published systematic review and meta-analysis comparing clinical benefits and complications for EVLP resuscitated donor lungs has not been identified. We conducted a systematic review in MEDLINE, Clinicaltrials.gov, and Cochrane from database inception through August 2019 of studies which included EVLP and non-EVLP comparisons, assessed risk of bias using the Newcastle-Ottawa scale, performed meta-analyses for primary outcomes with forest plots and evaluated the certainty of the evidence (CoE) with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Twelve cohort studies included the use of EVLP to resuscitate human donor lungs for transplantation. When compared with non-EVLP, EVLP may result in little to no difference in acute rejection (Relative Risk [RR]: 0.95, 95% confidence interval (CI) 0.82-1.09; low CoE) or Primary Graft Dysfunction (PGD) grade 3 at 72 hours (RR: 0.99, 95% CI 0.56-1.75, low CoE). Additionally, when compared with non-EVLP, we are very uncertain about the effects of EVLP on airway complications (RR: 1.83, 95% CI 0.65-5.17; very low CoE) or one-year post-transplant survival (RR: 1.00; 95% CI 0.95-1.05, very low CoE). The overall body of evidence was rated as low certainty. (Table) CONCLUSION: Acute rejection and PGD outcomes are similar for EVLP and non-EVLP, and airway complications and one-year post-transplant survival do not show certain harm, suggesting EVLP as a promising intervention to increase patient access to transplant.