Section of General Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, New York.
Department of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland.
J Heart Lung Transplant. 2020 Sep;39(9):954-961. doi: 10.1016/j.healun.2020.05.002. Epub 2020 May 16.
Ex vivo lung perfusion (EVLP) allows for a reassessment of lung grafts initially deemed unsuitable for transplantation, increasing the available donor pool; however, this requires a pre- and post-EVLP period of cold ischemic time (CIT). Paucity of data exists on how the sequence of cold normothermic-cold preservations affect outcomes.
A total of 110 patients were retrospectively analyzed. Duration of 3 preservation phases was measured: cold pre-EVLP, EVLP, and cold post-EVLP. The donor and recipient clinical data were collected. Primary graft dysfunction (PGD) and survival were monitored. Risk of mortality or PGD was calculated using Cox proportional hazards and logistic regression models to adjust for baseline characteristics.
Using the highest quartile, patients were stratified into extended vs non-extended pre-EVLP (<264 vs ≥264 minutes) and post-EVLP (<287 vs ≥287 minutes) CIT. The rates of 1-year mortality (8.4% vs 29.6%, p = 0.013), PGD 2-3 (20.5% vs 52%, p = 0.002), and PGD 3 (8.4% vs 29.6%, p = 0.005) at 72 hours were increased in the extended post-EVLP CIT group. After adjusting for baseline risk factors, the extended group remained an independent predictor of PGD ≥2 (odd ratio: 6.18, 95% CI: 1.88-20.3, p = 0.003) and PGD 3 (odd ratio: 20.4, 95% CI: 2.56-161.9, p = 0.004) at 72 hours and 1-year mortality (hazard ratio: 17.9, 95% CI: 3.36-95.3, p = 0.001). Cold pre-EVLP was not a significant predictor of primary outcomes.
Extended cold post-EVLP preservation is associated with a risk for PGD and 1-year mortality. Pre-EVLP CIT does not increase mortality or high-grade PGD. These findings from a multicenter trial should caution on the implementation of extended cold preservation after EVLP.
体外肺灌注 (EVLP) 允许重新评估最初被认为不适合移植的肺供体，从而增加可用的供体库; 然而，这需要在 EVLP 前和 EVLP 后进行一段冷缺血时间 (CIT)。关于冷常温-冷保存的顺序如何影响结果的数据很少。
回顾性分析了 110 例患者。测量了 3 个保存阶段的持续时间：EVLP 前冷、EVLP 中和 EVLP 后冷。收集供体和受体的临床数据。监测原发性移植物功能障碍 (PGD) 和存活率。使用 Cox 比例风险和逻辑回归模型计算死亡率或 PGD 的风险，以调整基线特征。
使用最高四分位数，患者被分为 EVLP 前延长（<264 分钟与≥264 分钟）和 EVLP 后延长（<287 分钟与≥287 分钟）CIT。72 小时时，1 年死亡率（8.4%与 29.6%，p=0.013）、PGD2-3（20.5%与 52%，p=0.002）和 PGD3（8.4%与 29.6%，p=0.005）的发生率在 EVLP 后 CIT 延长组中增加。在调整基线风险因素后，延长组仍然是 PGD≥2（优势比：6.18，95%CI：1.88-20.3，p=0.003）和 PGD3（优势比：20.4，95%CI：2.56-161.9，p=0.004）的独立预测因子72 小时和 1 年死亡率（风险比：17.9，95%CI：3.36-95.3，p=0.001）。EVLP 前的冷保存时间不是主要结局的显著预测因素。
EVLP 后冷保存时间延长与 PGD 和 1 年死亡率相关。EVLP 前的 CIT 不会增加死亡率或高等级 PGD。这项来自多中心试验的研究结果应警惕在 EVLP 后延长冷保存的实施。
