Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Clin Transplant. 2023 Feb;37(2):e14901. doi: 10.1111/ctr.14901. Epub 2023 Jan 11.
The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid- to long-term follow-up. In this study, we reviewed our institutional data to better understand the impact of EVLP.
Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed. Data were compared between lungs transplanted and declined after EVLP, between patients with severe primary graft dysfunction (PGD3) and no PGD3 after EVLP, and between matched patients with lungs transplanted with and without EVLP.
In total, 98 EVLP cases were performed. Changes in metabolic indicators during EVLP were correlated with graft quality and transplantability, but not changes in physiological parameters. Among 58 transplanted lungs after EVLP, PGD3 at 72 h occurred in 36.9% and was associated with preservation time, mechanical support prior to transplant, and intraoperative transfusion volume. Compared with patients without EVLP, patients who received lungs screened with EVLP had a higher incidence of PGD3 and longer ICU and hospital stays. Lung grafts placed on EVLP exhibited a significantly higher chance of developing airway anastomotic ischemic injury by 30 days posttransplant. Acute and chronic graft rejection, pulmonary function, and posttransplant survival were not different between patients with lungs screened on EVLP versus lungs with no EVLP.
EVLP use is associated with an increase of early posttransplant adverse events, but graft functional outcomes and patient survival are preserved.
离体肺灌注（EVLP）在多项临床研究中已证实其在肺移植中的安全性，但目前对于 EVLP 对移植后移植物并发症和中长期随访生存率的潜在影响的证据有限。在这项研究中，我们回顾了我们的机构数据，以更好地了解 EVLP 的影响。
回顾性分析 2014 年至 2020 年进行 EVLP 的肺脏和移植结果。对 EVLP 后进行移植和放弃的肺脏、EVLP 后发生严重原发性移植物功能障碍（PGD3）和无 PGD3 的患者、以及进行和未进行 EVLP 的匹配患者的肺脏进行了比较。
共进行了 98 例 EVLP 病例。EVLP 过程中代谢指标的变化与供体质量和可移植性相关，但与生理参数的变化无关。在 58 例接受 EVLP 后进行移植的肺脏中，72 小时时发生 PGD3 的比例为 36.9%，与保存时间、移植前机械支持和术中输血量有关。与未进行 EVLP 的患者相比，接受 EVLP 筛选的肺脏的患者 PGD3 发生率更高，重症监护病房和住院时间更长。与未接受 EVLP 的患者相比，接受 EVLP 处理的肺脏在移植后 30 天发生气道吻合口缺血性损伤的几率明显更高。急性和慢性移植物排斥反应、肺功能和移植后生存率在接受 EVLP 筛选的患者与未接受 EVLP 的患者之间没有差异。
EVLP 的使用与移植后早期不良事件的增加相关，但移植物功能结果和患者生存率得以保留。
