Early Pulmonary Function and Mid Term Outcome in Lung Transplantation after Ex Vivo Lung Perfusion- a single-center, retrospective, observational, cohort study

Outcomes after transplantation of lungs (LuTX) treated with Ex-Vivo Lung Perfusion (EVLP) are debated. In a single-center 8-years retrospective analysis we compared: donors’ and recipients’ characteristics, gas exchange and lung mechanics at ICU admission, 3, 6 and 12 months, and patients survival of LuTX from Standard donors compared to EVLP treated grafts. 193 LuTX were performed. Thirty-one LuTX, out of 50 EVLP procedures, were carried-out: 7 from non-heart-beating and 24 from extended criteria brain-dead donors. Recipients’ characteristics were similar. At ICU admission, compared to Standard donors, EVLP patients had worse PaO2/FiO2 (276 [206;374] vs. 204 [133;245] mmHg, p<0.05), more frequent extracorporeal support (18 vs. 32%, p=0.053) and longer mechanical ventilation duration (28-days ventilator-free days: 27 [24; 28] vs. 26 [19;27], p<0.05). ICU length of stay (4 [2;9] vs. 6 [3;12] days, p=0.208), 28-days survival (99 vs. 97%, p=0.735) and 1-year respiratory function were similar between groups. Log-rank analysis (median follow-up 2.5 years) demonstrated similar patients survival (p=0.439) and time free of chronic lung allograft disease (p=0.484). The EVLP program increased by 16% the number of LuTX. Compared to Standard donors, EVLP patients had worse respiratory function immediately after LuTX but similar early and mid-term outcomes.