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
{"title":"现实世界中供体肺远程集中体外肺灌注（rc-EVLP）相关结果","authors":"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","doi":"10.1016/j.xjon.2025.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>U</em> test.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 292-298"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes associated with remote, centralized ex vivo lung perfusion (rc-EVLP) for donor lungs in a real-world setting\",\"authors\":\"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\",\"doi\":\"10.1016/j.xjon.2025.04.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>U</em> test.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"26 \",\"pages\":\"Pages 292-298\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273625001329\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273625001329","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Outcomes associated with remote, centralized ex vivo lung perfusion (rc-EVLP) for donor lungs in a real-world setting
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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