Sequential Single Lung Transplant (SLT) with or without Ex-Vivo Lung Perfusion Maximizes on Donor to Transplant Conversion Rates

Abstract

Purpose A double lung donor may be split, with a single lung transplanted sequentially into two different recipients by one team. This minimizes utilization of hospital staff resources, day time theater access and supports donor to transplant conversion rates. This is a retrospective institutional review of the first 12 cases assessing the impact of extended ischemic time (for the delayed second lung transplant recipient) on length of stay (LOS), intermediate term graft function and survival. Methods Twelve sequential single lung transplants were performed from 6 donors between August 2016 and September 2017. Basic data for donors and recipients including outcomes (ischemic time, ICU stay, total hospital stay, 30 day mortality, 12-month survival including pulmonary function tests (PFTs)) were recorded. Borderline lungs were implanted to the EVLP circuit and reperfused using acellular supplemented Steen Solution (Vitrolife, Goteborg, Sweden). Recipients were categorized into 2 groups: G1 for patients who received the 1st lung, hence having a shorter ischemic time (whether they had EVLP or not), G2 for patients who received the 2nd lung, hence a longer ischemic time. 3 patients received EVLP reconditioned lungs. Results Donor data (n = 6) were: age, 44.2 ± 8.33 years; female/male, 5:1; cause of death: intracranial haemorrhage 4(66.6%), hypoxic brain injury 1(16.6%) and traumatic brain injury 1(16.6%). Mean LAS Score was similar for both groups (44.9 G1 and 41.7 G2, p value=0.64). Mean ischemic time from donor cross clamp to reperfusion was 389 minutes for G1 and 708 minutes for G2. There was no significant difference in ICU stay: 14.7 days vs 6.0 days with a quicker discharge from ITU in the G2(p value=0.20). The mean Hospital LOS was 32.3 vs 20.3 days, (p value= 0.35) Mean FEV1 at 3 months in G1 was 2.4 L (79.7%) and in G2 was 2.0 L (68.4%) (p value=0.38). No all cause 30 day mortality in both groups. At 1-year 2 patients had died from an unexpected bradycardic cardiac arrest. Conclusion SLT if limited resources are available maximize on donor to transplant conversion rates. Donor ischemic lung time is not a deterrent in the era of EVLP. SLT into two recipients by a single theater service is feasible, cost-effective and safe.