Thoracic: Lung Transplantation
Ex vivo lung evaluation of single donor lungs when the contralateral lung is rejected increases safe use

https://doi.org/10.1016/j.jtcvs.2022.03.012Get rights and content

Abstract

Objective

The decision to perform a single-lung transplant (SLT) when the contralateral donor lung is rejected is a challenging scenario. The introduction of ex vivo lung perfusion (EVLP) has improved donor lung assessment, and we hypothesize that it has improved SLT outcomes in this setting.

Methods

A retrospective single-center review of all SLTs performed between 2000 and 2017 was performed in which the years 2000 to 2008 were considered the “pre-EVLP era” and 2009 to 2017 the “EVLP era.” Recipients of SLT lungs when the contralateral lung was declined were classified into 3 groups: (1) Pre-EVLP era, (2a) EVLP era but EVLP not used, and (2b) EVLP era and EVLP used. The outcomes of interest were survival, time-to-extubation, and intensive care unit and hospital stay.

Results

Among 1692 transplants between 2000 and 2017, 244 (14%) were SLT. SLT rate was similar between eras (pre-EVLP 16% vs EVLP 15%), but more SLTs were performed where the contralateral lung was declined in the EVLP era (pre-EVLP 32% vs EVLP 45%, P = .04). Lungs evaluated on EVLP had lower procurement partial pressure of oxygen and were more often from donation after cardiac death donors. Recipients were generally also sicker, with a greater proportion of rapidly deteriorating recipients. Despite this, outcomes were similar between eras with a trend towards lower 30-day mortality in the EVLP era.

Conclusions

The availability of EVLP allowed for better evaluation of marginal single lungs when the contralateral was declined. This has led to increased use rates with preserved outcomes despite use of more extended criteria organs.

Section snippets

Methods

Data were retrospectively extracted from the prospectively collected database of the Toronto Lung Transplant Program. The study was approved by the University Health Network Research Ethics Board (18-6346) on February 2, 2019. A waiver for informed consent was provided, given the nature of the study.

To account for the introduction of clinical EVLP to our program in 2008, we considered the years 2000 to 2008 the “pre-EVLP era” and 2009 to 2017 the “EVLP era.” When one lung was declined at the

Results

A total of 1692 transplants were performed between 2000 and 2017, of which 244 (14%) were SLT. The proportion of SLT was similar between eras (66/524 [16%] pre-EVLP era vs 178/1168 [15%] EVLP era), but more SLTs were performed when the contralateral lung was declined in the EVLP era (21/66 SLTs [32%] pre-EVLP era vs 80/178 [45%] EVLP era, P = .04).

There were 21 (9%) in group 1, 33 (14%) in group 2a, and 47 (19%) in group 2b. Of the 47 in group 2b, 28 (60%) were started on EVLP as a double lung

Discussion

SLT is a valuable option for many patients and presents the opportunity for gaining maximal societal benefit from the scarce pool of donor organs, which remains a priority for transplantation in general.3,10,11 Accepting a single lung for transplant when the contralateral lung is deemed unsuitable could be an avenue for expanding the number of available lungs for transplant, but these are potentially greater-risk organs since the injurious process affecting one of the lungs may also have

References (12)

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The editorial review of this paper was handled by Associate Editor David Jones, MD.

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