Lung Transplantation from Donation after Circulatory Death Donors Following Portable Ex-Vivo Lung Perfusion: Post-Hoc Analysis of OCS Lung EXPAND Trial

Abstract

Purpose Donation after circulatory death (DCD) donors and ex-vivo lung perfusion (EVLP) both share the potential to attenuate lung shortage. We report the experience of the OCS Lung EXPAND trial on lung transplantation following EVLP for DCD pulmonary grafts. Methods OCS Lung EXPAND is an international multi-center clinical trial aiming to evaluate the safety and effectiveness of the OCS™ Lung to recruit, preserve and assess donor lungs that may not meet current standard donor lung acceptance criteria for transplantation. We performed a post-hoc analysis of the DCD donors. Data are reported as mean±standard deviation. Results Out of 93 OCS perfused donor lungs, 32 (34%) were DCD grafts of which 26 (81% utilization rate) were transplanted. Recipient age was 55±11 years; 18 male/ 8 female; indications were emphysema (n=11), fibrosis (n=5), cystic fibrosis (n=4), other (n=6); donor age was 40±14 years; 17 male/ 9 female. EVLP time was 389±127 min, final PO2/FiO2 was 403±84 mmHg. Pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and peak airway pressure (PAWP) remained stable during EVLP (Figure 1). Intensive care unit and hospital stay was 12±8 and 31±25 days, respectively. Time until first extubation was 5±8 days. Ratio of primary graft dysfunction grade 3 at 24, 48 and 72 hours was 15%, 8% and 8%, respectively. With a follow-up of 1 year, no acute rejections occurred and 1 patient developed chronic lung allograft dysfunction. Two patients died at 73 and 139 days post-transplant due to hyperkalemia and esophageal perforation; 24 patients were alive, resulting in a 1-year patient survival of 92%. Conclusion Portable EVLP is a safe and effective modality to assess functional performance of DCD lungs prior to transplantation, resulting in a high utilization rate and good clinical outcome.