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

Zhang L Zhang; Vincent van Suylen; Judith E van Zanden; Caroline Van De Wauwer; Erik A M Verschuuren; Wim van der Bij; Michiel E Erasmus

doi:10.1093/ejcts/ezy373

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

Eur J Cardiothorac Surg. 2019 May 1;55(5):920-926. doi: 10.1093/ejcts/ezy373.

Authors

Zhang L Zhang¹, Vincent van Suylen¹, Judith E van Zanden¹, Caroline Van De Wauwer¹, Erik A M Verschuuren², Wim van der Bij², Michiel E Erasmus¹

Affiliations

¹ Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
² Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.

PMID: 30496383
DOI: 10.1093/ejcts/ezy373

Abstract

Objectives: Despite 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 the lungs that would otherwise have been discarded. Herein, we present our centre's first EVLP experiences between July 2012 and June 2016, when we performed 149 LTxs.

Methods: It was a single-centre, retrospective analysis of a prospectively collected database. The EVLP group (n = 9) consisted of recipients who initially received 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. Both groups were compared on primary graft dysfunction (PGD) grades 0-3, pulmonary function, chronic lung allograft dysfunction and survival.

Results: In the EVLP group, 33% (3/9) developed PGD1 at 72 h post-LTx. In the N-EVLP group, 11% (2/18) developed PGD1, 6% (1/18) PGD2 and 11% (2/18) PGD3 at 72 h post-LTx. At 3 and 24 months post-LTx, forced expiratory volume in 1 s as percentage of predicted was similar in the EVLP (78% and 92%) and N-EVLP groups (69% and 89%). Forced vital capacity as a percentage of predicted was comparable in the EVLP (77% and 93%) and N-EVLP groups (68% and 101%). Chronic lung allograft dysfunction was diagnosed in 1 N-EVLP patient at 2 years post-LTx. Three-year survival was 78% (7/9) (the EVLP group) vs 83% (15/18) (the N-EVLP group).

Conclusions: These results are in line with the existing literature suggesting that transplantation of the previously discarded lungs recovered by EVLP leads to equal outcomes compared to conventional LTx methods.

Keywords: Ex vivo lung perfusion; (Chronic) lung (allograft) function/dysfunction; Donation after brain death; Donation after circulatory death; Lung transplantation/pulmonology; Patient survival.

MeSH terms

Adult
Aged
Female
Humans
Lung Transplantation* / adverse effects
Lung Transplantation* / methods
Lung Transplantation* / mortality
Lung* / physiology
Lung* / surgery
Male
Middle Aged
Netherlands
Primary Graft Dysfunction / physiopathology
Reperfusion / methods*
Retrospective Studies
Transplants* / physiology
Transplants* / transplantation