Ex Vivo Lung Perfusion and Lung Transplantation Practice Patterns in the United States
Ernest G. Chan, Rachel Deitz, Eric J. Hyzny, Jenalee N. Coster, John P. Ryan, Masashi Furukawa, Kentaro Noda, *Pablo G. Sanchez
Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Ex vivo lung perfusion holds the potential to increase lung transplants by providing the ability to re-evaluate organs initially deemed not suitable and in some cases facilitate logistics. We report the ongoing evolution of practice patterns associated with the use of EVLP for lung transplantation in the United States.
We performed a retrospective analysis of the United Network for Organ Sharing Database identifying all lung transplant recipients performed between March 2018 and June 2021. Inclusion criteria included adult undergoing lung transplantation. Exclusion criteria included patients who were missing data indicating if they were perfused. High volume centers were defined as centers that performed 35 or more transplants per year in at least one year of the study period.
During the study period, 442 out of 616 donor lungs placed on EVLP (71.6%) were transplanted, representing 5.1% of all lung transplants performed. 55.7% of EVLP lung transplants were performed during the day time (between 7AM and 7PM). On average, 126 EVLP transplants were performed annually in the US. In total, 55.1% of all lung transplant centers (38 out of 69) performed at least 1 EVLP transplant during the study period, with four centers performing 14 or more EVLP lung transplants in one year. Only 11% of lung transplant centers (8 out of 69) performed EVLP lung transplants every year and were responsible for 47% (n = 206) of all EVLP lung transplants. High volume centers performed the overwhelming majority of EVLP lung transplants each year since 2018 (Figure). Extended criteria accounted for 89.8 % of the lungs screened with EVLP: 54.3% (n = 240) had two ECD criteria, and 20.6% (n = 91) had three or more criteria. The majority of ECD lungs were from donors with an abnormal chest x-ray (73.8%). Donors from donation after circulatory determination of death accounted for 3.8% (n = 17) of EVLP transplanted lungs. Survival was not different between patients who received EVLP vs standard donation lungs (p = 0.17). Similarly, survival in patients who received EVLP lungs did not differ in high vs low volume centers (p = 0.22).
The use of EVLP lungs remains a safe, but underutilized, resource for lungs with extended donation criteria, typically for lungs with abnormal chest x-rays. Although a small percentage of centers utilized a high proportion of EVLP lungs, there was no relationship between center volume and survival outcomes suggesting that all centers could benefit from the use of EVLP to increase the available number of donors.
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