Three Center Experience with Clinical Normothermic Ex Vivo Lung Perfusion

Abstract

Purpose Normothermic ex vivo lung perfusion (EVLP) is a method to evaluate and improve function of injured donor lungs. We reviewed 3-center experience using the previously described Toronto EVLP technique. Methods and Materials A retrospective study of independently collected data from 3 centers and then combined for this analysis. Brain death donor (BDD) and cardiac death donor (DCD) lungs considered to be of high risk for transplantation were subjected to 3-6h of EVLP. Lungs that achieved stable airway and vascular pressures, and a delta PaO 2 /FiO 2 over 350mmHg during EVLP were considered for transplantation. Utilization rates after EVLP, incidence of primary graft dysfunction (PGD) ISHLT grade 3 at 24h and 72h after transplantation, duration of mechanical ventilation, hospital length of stay (LOS), airway complications, and proportional survival at 1year were analyzed. Results Between Sept 2008 and Aug 2012, a total of 125 clinical EVLP were performed. Ninety (72%) were BDD lungs and 35(28%) were DCD lungs. Of the 125 procedures, 103 lungs (82.5% utilization after EVLP) were subsequently transplanted. Median donor PaO 2 /FiO 2 was 268(92-529) mmHg. Recipient diagnosis was emphysema (n=32), pulmonary fibrosis (n=31), cystic fibrosis (n=28), and other (n=12). Seven patients (7%) were on extracorporeal life support prior to LTx. Incidence of PGD 3 at 24h and 72h were 7% and 5% respectively. Median time to extubation, and hospital LOS were 2 (1-99) and 23(7-120) days. Thirty-day mortality was 4% and proportional survival at 1 year was 88%. Airway complications requiring intervention occurred in 6 patients (6%). Conclusions This is the largest report to date of EVLP in clinical lung transplantation. 85% of lungs treated with EVLP were successfully transplanted with excellent short and intermediate outcomes. This strategy promises to further increase the safe utilization rates of questionable donor lungs and the overall outcomes of lung transplantation.