How to Assess EVLP Lungs in Standard Clinical Use?

Abstract

<h3>Purpose</h3> Ex-vivo lung perfusion (EVLP) is currently considered a valuable option to preserve, reassess or recondition pulmonary grafts prior to lung transplantation (LTx). Both standard and extended criteria donors lungs have been studied in clinical trials. Usually, a 20% deterioration of physiological parameters during EVLP is considered detrimental for the graft and a reason to decline it. In this study, we report the relation between EVLP parameters and primary graft dysfunction (PGD) in a clinical LTx program. <h3>Methods</h3> In our center the TransMedics OCS^TM Lung device is used. The indication for EVLP was combined organ transplantation, graft re-assessment or prolonged preservation based on an institutional algorithm and available resources. Standard clinical EVLP parameters (mean pulmonary artery pressure (PAP), vascular resistance (VR) and driving airway pressure(DAP)) were compared between the first and final assessment. The % difference (Δ) between these time points was calculated. Graft outcome was expressed as presence of any PGD grade 3 (PGD 3) within 72 hours. Statistical analysis was performed using student T-test comparing patients with PGD 3 vs. without. Combined organ (liver-LTx) and LTx cases were analyzed separately as well as together. <h3>Results</h3> Data are presented in figure 1. In total, 12 lungs were included. Overall, all grafts met acceptance criteria during EVLP and were transplanted. Despite this, 58% of the patients developed PGD 3. No statistically significant difference in EVLP parameters was observed between patients who developed and did not develop PGD 3. <h3>Conclusion</h3> Overall, the clinical EVLP parameters were within the limits of acceptance and even improved over time. Despite this, we observed a high incidence of PGD 3. At this moment it is not clear how to assess EVLP lungs in clinical use and predict the outcome after LTx. The role of EVLP in post-reperfusion injury requires further research.