Transplantation after ex vivo lung perfusion: A midterm follow-up

详细信息    查看全文

• 作者：Andreas Wallinder ; MD ; PhD^a ; ^b ; ^{andreas.wallinder@vgregion.se" class="auth_mail" title="E-mail the corresponding author} ; Gerdt C. Riise ; MD ; PhD^c ; Sven-Erik Ricksten ; MD ; PhD^d ; Martin Silverborn ; MD ; PhD^a ; ^b ; Gö ; ran Dellgren ; MD ; PhD^a ; ^b ; ^c
• 关键词：lung transplantation ; ex vivo lung perfusion ; lung evaluation ; chronic lung allograft dysfunction ; primary graft dysfunction
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：35
• 期：11
• 页码：1303-1310
• 全文大小：372 K

文摘

A large proportion of donor lungs are discarded due to known or presumed organ dysfunction. Ex vivo lung perfusion (EVLP) has proven its value as a tool for discrimination between reversible and irreversible donor lung pathology. However, the long-term outcome after transplantation of lungs after EVLP is essentially unknown. We report short-term and midterm outcomes of recipients who received transplants of EVLP-evaluated lungs.

Methods

Single-center results of recipients of lungs with prior EVLP were compared with consecutive recipients of non-EVLP lungs (controls) during the same period. Short-term follow-up included time to extubation, time in the intensive care unit, and the presence of primary graft dysfunction at 72 hours postoperatively. Mortality and incidence of chronic lung allograft dysfunction were monitored for up to 4 years after discharge.

Results

During a 4-year period, 32 pairs of initially rejected donor lungs underwent EVLP. After EVLP, 22 double lungs and 5 single lungs were subsequently transplanted. During this period, 145 patients received transplants of conventional donor lungs that did not have EVLP and constituted the control group. Median time to extubation was 7 hours in the EVLP group and 6 hours in the non-EVLP control group (p = 0.45). Median intensive care unit stay was 4 days vs. 3 days, respectively (p = 0.15). Primary graft dysfunction grade > 1 was present in 14% in the EVLP group and in 12% in the non-EVLP group at 72 hours after transplant. Survival at 1 year was 92% in the EVLP group and 79% in the non-EVLP group. Cumulative survival and freedom from retransplantation or chronic rejection were also comparable between the 2 groups (p = 0.43) when monitored up to 4 years.

Conclusions

Selected donor lungs rejected for transplantation can be used after EVLP. This technique is effective for selection of transplantable donor lungs. Patients who received lungs evaluated under EVLP have short-term and midterm outcomes comparable to recipients of non-EVLP donor lungs.