The Complete Score for Assessment of Donor Lungs: A Comprehensive Evaluation System in Clinical Ex-Vivo Lung Perfusion

Abstract

Purpose Evaluating marginal donor lungs for transplant suitability in acellular ex-vivo lung perfusion (EVLP) can be challenging. Relying on a single parameter for evaluation can be misleading and may result in unfavorable outcomes following lung transplantation (LTx). This study aimed to establish a comprehensive scoring system incorporating important evaluation parameters in a simple reproducible way. Methods The comp rehensive l ung e valua t ion E VLP ( COMPLETE ) score is the composite result of ten evaluation parameters including: lung weight measurement, ultrasound evaluation, airway pressure, lung compliance, P/F ratio, lactate level, deflation, palpation, bronchoscopy, and x-ray. Each parameter is scored from 0 to 3, 3 being the worst, then the COMPLETE score is calculated by the summation of the individual parameter scores. Data was collected prospectively, then analyzed retrospectively utilizing receiver operating characteristic (ROC) analysis to inform the cut off values for each parameter scoring. Results Seventy-three EVLP cases were performed resulting in 48 lung transplants with 100% 30-day survival and 96% 1-year survival. Median time to extubation was 1 day and median ICU stay was 7 days. The incidence of primary graft dysfunction (PGD) grades 0, 1, 2, and 3 at 72 hours were 23%, 61%, 9%, and 7%, respectively. The COMPLETE score was significantly higher in lungs non-suitable for LTx compared to transplanted lungs (17 [15-20] vs 7 [4-8], P Conclusion The COMPLETE scoring system is a comprehensive system that can facilitate decision making in EVLP in a protocolized manner. The COMPLETE score was significantly higher in EVLP lungs deemed non-suitable for transplant and, in those transplanted after EVLP, the COMPLETE score had a significant correlation with time to extubation, ICU stay, and incidence of PGD3. Consideration should be given to the routine use of the COMPLETE score during EVLP evaluation.