Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Ann Surg. 2022 May 1;275(5):1006-1012. doi: 10.1097/SLA.0000000000004233. Epub 2020 Jul 24.
The objective of this study was to examine early lung transplant outcomes following EVLP using a large national transplant registry.
Lung transplantation in the United States continues to be constrained by a limited supply of donor organs. EVLP has the potential to significantly increase the available pool of donor lung allografts through the reconditioning of "marginal" organs.
The united network for organ sharing registry was queried for all adults (age ≥18) who underwent first-time lung transplantation between March 2018 (when united network for organ sharing began collecting confirmed donor EVLP status) and June 2019. Transplants were stratified by EVLP use. The primary outcome was short-term survival and secondary outcomes included acute rejection before discharge and need for extracorpo-real membrane oxygenation support post-transplant.
A total of 3334 recipients met inclusion criteria including 155 (5%) and 3179 (95%) who did and did not receive allografts that had undergone EVLP, respectively. On unadjusted descriptive analysis, EVLP and non-EVLP cohorts had similar 180-day survival (92% vs 92%, P = 0.9). EVLP use was associated with a similar rate of acute rejection (13% vs 9%, P = 0.08) but increased rate of early extracorporeal membrane oxygenation use (12% vs 7%, P = 0.04). After adjustment, EVLP use was not associated with significantly increased mortality (adjusted hazard ratio 0.99, 95% confidence interval 0.62-1.58) or acute rejection (adjusted odds ratio 0.89, 95% confidence interval 0.40-1.97) compared to non-EVLP use.
In the largest national series of EVLP lung transplant recipients, EVLP is associated with early recipient outcomes comparable to that of non-EVLP recipients with similar baseline characteristics. Longer term follow-up data is needed to further assess the impact of EVLP on post-lung transplant outcomes.
本研究旨在使用大型国家移植登记处，检查使用 EVLP 后的早期肺移植结果。
美国的肺移植仍然受到供体器官有限供应的限制。EVLP 有可能通过对“边缘”器官进行再处理，显著增加可用于肺同种异体移植的供体肺移植物的数量。
查询了 2018 年 3 月（当联合器官共享网络开始收集确认的供体 EVLP 状态时）至 2019 年 6 月期间首次进行肺移植的所有成年人（年龄≥18 岁）的联合网络器官共享登记处。根据 EVLP 使用情况对移植进行分层。主要结果是短期生存率，次要结果包括出院前急性排斥反应和移植后需要体外膜氧合支持。
共有 3334 名符合纳入标准的受者，其中 155 名（5%）和 3179 名（95%）分别接受和未接受经过 EVLP 的同种异体移植物。在未调整的描述性分析中，EVLP 和非-EVLP 队列的 180 天生存率相似（92% vs 92%，P=0.9）。EVLP 使用与相似的急性排斥反应率相关（13% vs 9%，P=0.08），但早期体外膜氧合使用率较高（12% vs 7%，P=0.04）。调整后，EVLP 使用与死亡率增加无关（调整后的危险比 0.99，95%置信区间 0.62-1.58）或急性排斥反应（调整后的优势比 0.89，95%置信区间 0.40-1.97）与非-EVLP 相比。
在最大的 EVLP 肺移植受者的国家系列中，EVLP 与具有相似基线特征的非-EVLP 受者的早期受者结局相当。需要进行更长时间的随访数据，以进一步评估 EVLP 对肺移植后结果的影响。
