First experience with ex-vivo lung perfusion for initially discarded donor lungs in the Netherlands, a single center study

Z.L. Zhang, V. van Suylen, J.E. van Zanden, C. van de Wauwer, E.A.M. Verschuuren, W. van der Bij, M.E. Erasmus

Wednesday 13 march 2019

14:30 - 14:32h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: Despite ongoing progress in lung transplantation (LTx) techniques, a shortage of donor lungs persists worldwide. Ex-vivo lung perfusion (EVLP) is a technique that evaluates, optimizes and enables transplantation of lungs that would otherwise have been discarded. Here we present our center’s first EVLP experiences between July 2012 and June 2016, when we performed 149 LTx.

Methods: This study was a single center, retrospective analysis of a prospectively collected database. The EVLP group (n=9) consisted of recipients who received initially discarded donor lungs that were reconditioned using EVLP. The non-EVLP (N-EVLP) group (n=18) consisted of data-matched patients receiving conventional quality lungs in the conventional way. Cases were matched based on surgery dates, the recipients’ underlying lung disease, and donor type (donation after brain death or controlled donation after circulatory death). Donor lungs that met any of the following indications were included in the EVLP procedure: 1) lungs with a PaO₂/fraction of inspired oxygen (FiO₂) < 40 kPa at a positive end expiratory pressure (PEEP) of 5 cmH₂O and 100% oxygen with clinically evident lung edema; 2) lungs that had a persistent low PaO₂/FiO₂< 40 kPa after active lung recruitment without a clear reason. Both study groups were compared on primary graft dysfunction (PGD) grades 0-3, pulmonary function, chronic lung allograft dysfunction (CLAD) and survival.

Results: In the EVLP group, 33% (3/9) developed PGD1 at 72 hours post-LTx. In the N-EVLP group, 11% (2/18) developed PGD1, 6% (1/18) PGD2 and 11% (2/18) PGD3 at 72 hours post-LTx. At 3 and 24 months post-LTx, FEV1 as percentage of predicted was similar in the EVLP (78% and 92%) and N-EVLP group (69% and 89%). Forced vital capacity as a percentage of predicted was comparable in the EVLP (77% and 93%) and N-EVLP group (68% and 101%). CLAD was diagnosed in one N-EVLP patient at two years post-LTx. Three-year survival was 78% (7/9) (EVLP group) versus 83% (15/18) (N-EVLP group).

Conclusions: By accepting discarded lungs for EVLP, the addition of this single center EVLP procedure increased the number of LTx by 6.4% (9 EVLP/149 LTx). These results are in line with existing literature that suggests that transplantation of previously discarded donor lungs, recovered by EVLP, leads to equal outcomes compared to conventional LTx methods.