Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Lung Transplant Service, Alfred Hospital, Melbourne, Australia.
Lung Transplant Service, Alfred Hospital, Melbourne, Australia.
Ann Thorac Surg. 2021 Apr;111(4):1156-1163. doi: 10.1016/j.athoracsur.2020.06.081. Epub 2020 Sep 2.
Although it is intense in health care resources, by facilitating assessment and reconditioning, ex vivo lung perfusion (EVLP) has the potential to expand the donor pool and improve lung transplant outcomes. However, inclusion criteria used in EVLP trials have not been validated.
This retrospective study from 2014 to 2018 reviewed our local state-based donation organization donor records as well as subsequent recipient outcomes to explore the relation between EVLP indications used in clinical trials and recipient outcomes. The primary outcome was primary graft dysfunction grade 3 at 24 hours, with 30-day mortality and posttransplant survival time as secondary outcomes, compared with univariate and multivariate analysis.
From 705 lung donor referrals, 304 lung transplantations were performed (use rate of 42%); 212 of recipients (70%) met at least 1 of the commonly cited EVLP initiation criteria. There was no significant difference in primary graft dysfunction grade 3 or 30-day mortality between recipients with or without an EVLP indication (10.2% versus 7.8%, P = .51; and 2.4% versus 0%, P = .14, respectively). Multivariate analyses showed no significant relationship between commonly cited EVLP criteria and primary graft dysfunction grade 3 or survival time. Recipient outcomes were significantly associated with recipient diagnosis.
At least 1 commonly cited criterion for EVLP initiation was present in 70% of the transplanted donors, and yet it did not predict clinical results; acceptable outcomes were seen in both subgroups. To discover the true utility of EVLP beyond good clinical management and focus EVLP on otherwise unacceptable lungs, a reconsideration of EVLP inclusion criteria is required.
虽然体外肺灌注（EVLP）在医疗资源方面要求较高，但它具有评估和再调理的能力，有可能扩大供体池并改善肺移植的结果。然而，EVLP 试验中使用的纳入标准尚未得到验证。
这项回顾性研究从 2014 年到 2018 年，对我们当地的州级捐赠组织的捐赠者记录以及随后的接受者结果进行了回顾，以探讨临床试验中使用的 EVLP 指征与接受者结果之间的关系。主要结果是 24 小时时的原发性移植物功能障碍 3 级，次要结果是 30 天死亡率和移植后生存时间，并进行了单变量和多变量分析。
在 705 例肺供体推荐中，进行了 304 例肺移植（使用率为 42%）；212 例接受者（70%）符合至少 1 项常见的 EVLP 启动标准。有或没有 EVLP 指征的接受者之间，原发性移植物功能障碍 3 级或 30 天死亡率没有显著差异（10.2%比 7.8%，P=.51；2.4%比 0%，P=.14）。多变量分析显示，常见的 EVLP 标准与原发性移植物功能障碍 3 级或生存时间之间没有显著关系。接受者的诊断与接受者的结局显著相关。
至少有 1 项常见的 EVLP 启动标准在 70%的移植供体中存在，但它并不能预测临床结果；在两个亚组中都可以看到可接受的结果。为了发现 EVLP 在良好的临床管理之外的真正用途，并将 EVLP 集中在其他不可接受的肺上，需要重新考虑 EVLP 的纳入标准。
