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Comparative Study
. 2019 Jul 1;14(1):125.
doi: 10.1186/s13019-019-0948-1.

Ten year follow-up of lung transplantations using initially rejected donor lungs after reconditioning using ex vivo lung perfusion

Haider Ghaidan  1 , Mohammed Fakhro  1 , Jesper Andreasson  1 , Leif Pierre  1 , Richard Ingemansson  1 , Sandra Lindstedt  2   3
Affiliations
Comparative Study

Ten year follow-up of lung transplantations using initially rejected donor lungs after reconditioning using ex vivo lung perfusion

Haider Ghaidan et al. J Cardiothorac Surg. .

Abstract

Background: In 2006 and 2007 we performed double lung transplantation with marginal donor lungs assessed and reconditioned by Ex Vivo Lung Perfusion (EVLP), using a technique developed by Professor Stig Steen. Here we present a 10-year follow-up comparing the outcomes of lung transplantations performed at our clinic using EVLP lungs vs. conventional lungs.

Method: Between 2006 and 2007, 21 patients (6 EVLP, 15 conventional) underwent double lung transplantation (LTx) with follow-up on May 2017 at Lund University Hospital, Sweden. Pulmonary function was measured at 3/6/12 months, and annually thereafter for a period of 10 years in addition to survival and freedom from chronic lung allograft dysfunction (CLAD) being analyzed.

Results: Regarding Forced Expiratory Volume in 1 s (FEV1) and 6MWT at 3, 6, and 12 months and annually thereafter, no difference in median FEV1 nor 6MWT was found for EVLP-LTx vs. conventional-LTx (p > 0.05). No difference was shown in post-operative survival between EVLP-LTx vs. conventional LTx for patients with an overall survival up to 10-years (p > 0.05). The same pattern was shown in sub analyses for patients with a limited survival up to 1 and 5 years (p > 0.05).

Conclusion: No superiority was found in conventional-LTx over EVLP-LTx, neither in long-term survival nor pulmonary function. No difference in CLAD-free survival was seen between the two groups. We believe that EVLP is a safe and effective method to use in LTx, greatly increasing the donor pool by improving marginal lungs and providing an objective assessment of the viability of marginal donor lungs.

Keywords: EVLP; Long-term follow up; Lung function; Lung transplantation; Survival.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The upper right Kaplan-Meier figure illustrates post-transplant survival for ex vivo lung perfusion (EVLP) lung transplantation (LTx) vs. conventional LTx for recipients transplanted between 2006 and 2007 with a limited survival up to 1 year (p > 0.05) while the upper left figure displays recipients with a limited survival up to 5 years. The bottom figure displays overall post-transplant survival in the 10-year experience for LTx-recipients (EVLP-LTx and conventional LTx) (p > 0.05)
Fig. 2
Fig. 2
Kaplan-Meier figure displaying freedom from CLAD for ex vivo lung perfusion (EVLP) lung transplantation (LTx) vs. conventional LTx for recipients transplanted between 2006 and 2007 until follow-up or death/Re-LTx (p < 0.05)
Fig. 3
Fig. 3
Median pulmonary function with 95% confidence interval is shown over time (years) after lung transplantation (LTx). Median forced expiratory volume in 1 s (FEV1) in liters is displayed to the right while 6-min walking test (6MWT) in expected work percentage is shown to the left for Ex vivo Lung Perfusion (EVLP) -LTx and conventional-LTx, respectively
See this image and copyright information in PMC

References

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