Outcomes associated with remote, centralized ex vivo lung perfusion (rc-EVLP) for donor lungs in a real-world setting

IF 1.9

JTCVS open Pub Date : 2025-08-01 DOI:10.1016/j.xjon.2025.04.002

Anil J. Trindade MD , Caitlin T. Demarest MD, PhD , John W. Stokes MD , Mathew Thomas MBBS, MD , Ian Makey MD , Matthew Bacchetta MD, MBA , Jorge Mallea MD

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Abstract

Objective

Ex vivo lung perfusion (EVLP) has resulted in a significant increase in the use of extended-criteria donor lungs without negatively impacting survival outcomes. However, in-house EVLP is resource-intensive, thereby limiting accessibility. Remote, centralized EVLP (rc-EVLP) has been used with acceptable outcomes in a highly protocolized feasibility study, although has not been assessed in a clinical setting. We characterized outcomes of rc-EVLP in a real-world setting and provide clinical associations related to donor use.

Methods

We performed a dual-center, retrospective analysis of consecutive extended-criteria donor lungs evaluated on rc-EVLP between December 1, 2020, and March 20, 2023. Outcomes included transplantation rate, predictors of use, incidence of primary graft dysfunction grade 3 (PGD3), and 1-year survival. Group comparisons were examined using the Fisher exact test or Mann-Whitney U test.

Results

Eighty-two donors were assessed by rc-EVLP; 65% would've been excluded in the previous feasibility trial. Forty-six lungs (56%) were ultimately transplanted. Vascular permeability, static compliance, and oxygen transfer all were associated with use. PGD3 incidence in rc-EVLP recipients was 17%, whereas 1-year survival was 93%. Donor from circulatory death (DCD) lungs assessed by rc-EVLP had a use of 6 of 19 (33%). Greater preprocurement partial pressure of oxygen, arterial/fraction of inspired oxygen ratio and greater oxygen transfer and static compliance assessed after 2 hours on EVLP were associated with increased DCD use. Although PGD3 incidence with DCD lungs was 33%, there was 100% 1-year recipient survival. Finally, 2-hour EVLP assessments may be sufficient for determining donor quality for all lungs.

Conclusions

Remote, centralized EVLP increases the use of extended-criteria donor lungs in a real-world setting and is associated with excellent outcomes. We provide objective criteria that are associated with the decision to use donor from brain death and DCD lungs assessed by rc-EVLP.

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现实世界中供体肺远程集中体外肺灌注（rc-EVLP）相关结果

目的体外肺灌注（EVLP）导致扩展标准供体肺的使用显著增加，但对生存结果没有负面影响。然而，内部EVLP是资源密集型的，因此限制了可访问性。远程集中式EVLP （rc-EVLP）在一项高度程序化的可行性研究中得到了可接受的结果，尽管尚未在临床环境中进行评估。我们在现实环境中描述了rc-EVLP的结果，并提供了与供体使用相关的临床关联。方法：我们对2020年12月1日至2023年3月20日期间连续进行rc-EVLP评估的扩展标准供体肺进行了双中心回顾性分析。结果包括移植率、使用预测因素、原发性移植物功能障碍3级（PGD3）发生率和1年生存率。组间比较采用Fisher精确检验或Mann-Whitney U检验。结果采用rc-EVLP对72例供体进行了评估；65%在之前的可行性试验中被排除在外。46个肺（56%）最终被移植。血管通透性、静态顺应性和氧转移都与使用有关。PGD3在rc-EVLP患者中的发病率为17%，而1年生存率为93%。rc-EVLP评估的循环性死亡（DCD）肺供体19例中有6例（33%）被使用。在EVLP治疗2小时后，更大的获取前氧分压、动脉/吸入氧比、更大的氧转移和静态依从性评估与DCD使用增加有关。尽管PGD3在DCD肺中的发病率为33%，但接受者的1年生存率为100%。最后，2小时EVLP评估可能足以确定所有肺的供体质量。结论：远程、集中式EVLP增加了现实环境中扩展标准供体肺的使用，并具有良好的预后。我们提供了与决定使用脑死亡供体和通过rc-EVLP评估的DCD肺相关的客观标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量