Use of Normothermic Perfusion Machines in Lung Transplantation: Consensus Statement of the Italian Society of Organ and Tissues Transplantation Group With DELPHI Method

Background: Ex vivo lung perfusion (EVLP) is a technique for graft preservation, evaluation and treatment, that could expand donor pool for transplantation. Nevertheless, the wide spectrum of available platforms has generated disparities in use, outcome, and costs. This study is an attempt to create a national consensus on EVLP use by a group of experts from the Italian Society of Organ Transplantation. Methods: The 9-member promoting committee was divided into 3 groups to propose statements. Using the DELPHI method 27 experts (three from each of the 9 lung transplant centres) voted agreement to each statement in 3 rounds. The cutoff for acceptance was set at 80% agreement. Results: In the first vote, 52 statements were proposed, and an agreement was reached for 20 of them (38%). After revision, the second round resulted in a quorum for 36 out of 40 statements proposed (90%). At the third vote, agreement was confirmed for 36 statements (8 indications for use, 19 modalities for use, 13 evaluation parameters). Conclusion: The statements outlined in this document do not represent absolute guidelines, but rather recommendations. The statements selected and presented are therefore aimed to assist Italian clinicians in the use of an ex vivo normothermic perfusion platform in the right context.