Long-term Outcomes of Lung Transplant With Ex Vivo Lung Perfusion

Importance: The mortality rate for individuals on the wait list for lung transplant is 15% to 25%, and still only 20% of lungs from multiorgan donors are used for lung transplant. The lung donor pool may be increased by assessing and reconditioning high-risk extended criteria donor lungs with ex vivo lung perfusion (EVLP), with similar short-term outcomes. Objective: To assess the long-term outcomes of transplant recipients of donor lungs treated with EVLP. Design, Setting, and Participants: This retrospective cohort single-center study was conducted from August 1, 2008, to February 28, 2017, among 706 recipients of donor lungs not undergoing EVLP and 230 recipients of donor lungs undergoing EVLP. Exposure: Donor lungs undergoing EVLP. Main Outcomes and Measures: The incidence of chronic lung allograft dysfunction and allograft survival during the 10-year EVLP era were the primary outcome measures. Secondary outcomes included donor characteristics, maximum predicted percentage of forced expiratory volume in 1 second, acute cellular rejection, and de novo donor-specific antibody development. Results: This study included 706 patients (311 women and 395 men; median age, 50 years interquartile range, 34-61 years) in the non-EVLP group and 230 patients (85 women and 145 men; median age, 46 years interquartile range, 32-55 years) in the EVLP group. The EVLP group donors had a significantly lower mean (SD) Pao2:fraction of inspired oxygen ratio than the non-EVLP group donors (348 108 vs 422 88 mm Hg; P < .001), higher prevalence of abnormal chest radiography results (135 of 230 58.7% vs 349 of 706 49.4%; P = .02), and higher proportion of smoking history (125 of 204 61.3% vs 322 of 650 49.5%; P = .007). More recipients in the EVLP group received single-lung transplants (62 of 230 27.0% vs 100 of 706 14.2%; P < .001). There was no significant difference in time to chronic lung allograft dysfunction between the EVLP and non-EVLP group (70% vs 72% at 3 years; 56% vs 56% at 5 years; and 53% vs 36% at 9 years; log-rank P = .68) or allograft survival between the EVLP and non-EVLP groups (73% vs 72% at 3 years; 62% vs 58% at 5 years; and 50% vs 44% at 9 years; log-rank P = .97) between the 2 groups. All secondary outcomes were similar between the 2 groups. Conclusions and Relevance: Since 2008, 230 of 936 lung transplants (24.6%) in the Toronto Lung Transplant Program were performed after EVLP assessment and treatment. Use of EVLP-treated lungs led to an increase in the number of patients undergoing transplantation, with comparable long-term outcomes.