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. 2022 Dec 14:1:988950.
doi: 10.3389/frtra.2022.988950. eCollection 2022.

Is logistically motivated ex vivo lung perfusion a good idea?

Caroline Van De Wauwer  1 , Vincent van Suylen  1 , Zhang L Zhang  1 , Erik A M Verschuuren  2 , Wim van der Bij  2 , C Tji Gan  2 , Rinse Ubbink  1 , Michiel E Erasmus  1
Affiliations

Is logistically motivated ex vivo lung perfusion a good idea?

Caroline Van De Wauwer et al. Front Transplant. .

Abstract

Ex vivo lung perfusion (EVLP) is a technique for reconditioning and evaluating lungs. However, the use of EVLP for logistical reasons is still under discussion. In this retrospective study, all EVLPs performed between July 2012 and October 2019 were analyzed for ventilation and perfusion data. After transplantation, primary graft dysfunction (PGD), lung function, chronic lung allograft dysfunction (CLAD)-free survival, and overall survival were analyzed. Fifty EVLPs were performed: seventeen logistic EVLPs led to 15 lung transplantations (LT) and two rejections (LR), and 33 medical EVLPs resulted in 26 lung transplantations (MT) and seven rejections (MR). Pre-EVLP PaO2 was lower for MT than LT (p < 0.05). Dynamic lung compliance remained stable in MT and LT but decreased in MR and LR. Plateau airway pressure started at a higher level in MR (p < 0.05 MT vs. MR at T60) and increased further in LR. After transplantation, there were no differences between MT and LT in PGD, lung function, CLAD-free survival, and overall survival. In addition, the LT group was compared with a cohort group receiving standard donor lungs without EVLP (LTx). There were no significant differences between LT and LTx for PGD, CLAD-free survival, and overall survival. FVC was significantly lower in LT than in LTx after 1 year (p = 0.005). We found that LT lungs appear to perform better than MT lungs on EVLP. In turn, the outcome in the LT group was comparable with the LTx group. Overall, lung transplantation after EVLP for logistic reasons is safe and makes transplantation timing controllable.

Keywords: ex vivo lung perfusion; logistic; lung transplantation; medical; primary graft dysfunction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pulmonary graft function during EVLP. (A) Oxygenation (PaO2 in kPa). (B) Pulmonary vascular resistance (PVR in dynes × s × cm−5). (C) Dynamic lung compliance (ml/cmH2O). (D) Plateau airway pressure (cmH2O). MT, medical EVLP with transplantation; MR, medical EVLP with rejection; LT, logistical EVLP with transplantation; LR, logistical EVLP with rejection. ▵MT vs. LT, p < 0.0001; ■MR vs. MT, p < 0.05.
Figure 2
Figure 2
Primary graft dysfunction after lung transplantation at T48 and T72. There was no significant difference between MT and LT at T48 and T72. MT, medical EVLP with transplantation; LT, logistical EVLP with transplantation.
Figure 3
Figure 3
Primary graft dysfunction after lung transplantation at T48 and T72. There was no significant difference between LTx and LT at T48 and T72. LTx, standard lung transplantation; LT, logistical EVLP with transplantation.
Figure 4
Figure 4
Lung function. (A) Forced expiratory volume in 1 second (FEV1) as a percentage of predicted pre-LTx and at 3, 6, and 12 months post-LTx. (B) Forced vital capacity (FVC) as a percentage of predicted pre-LTx and at 3, 6, and 12 months post-LTx. MT, medical EVLP with transplantation; LT, logistical EVLP with transplantation.
Figure 5
Figure 5
Lung function. (A) Forced expiratory volume in 1 second (FEV1) as a percentage of predicted pre-LTx and at 3, 6, and 12 months post-LTx. (B) Forced vital capacity (FVC) as a percentage of predicted pre-LTx and at 3, 6, and 12 months post-LTx. LTx, standard lung transplantation; LT, logistical EVLP with transplantation.
Figure 6
Figure 6
Chronic lung allograft dysfunction-free survival. MT, medical EVLP with transplantation; LT, logistical EVLP with transplantation.
Figure 7
Figure 7
Chronic lung allograft dysfunction-free survival. LTx, standard lung transplantation; LT, logistical EVLP with transplantation.
Figure 8
Figure 8
Patient survival. MT, medical EVLP with transplantation; LT, logistical EVLP with transplantation.
Figure 9
Figure 9
Patient survival. LT, logistical EVLP with transplantation; LTx, standard lung transplantation.
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