Buttar Sana N, Schultz Hans Henrik L, Møller-Sørensen Hasse, Perch Michael, Petersen Rene Horsleben, Møller Christian H
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Front Transplant. 2024 Feb 6;3:1324851. doi: 10.3389/frtra.2024.1324851. eCollection 2024.
lung perfusion (EVLP) has demonstrated encouraging short- and medium-term outcomes with limited data available on its long-term outcomes. This study assesses (1) EVLP long-term outcomes and (2) EVLP era-based sub-analysis in addition to secondary outcomes of recipients with EVLP-treated donor lungs compared with recipients of conventionally preserved donor lungs in unmatched and propensity score-matched cohorts. Double lung transplants performed between 1st January 2012 and 31st December 2021 were included. A total of 57 recipients received EVLP-treated lungs compared to 202 unmatched and 57 matched recipients who were subjected to non-EVLP-treated lungs. The EVLP group had a significantly lower mean PaO/FiO ratio and significantly higher mean BMI than the non-EVLP group in the unmatched and matched cohorts. The proportion of smoking history in the unmatched cohort was significantly higher in the EVLP group, while a similar smoking history was demonstrated in the matched cohorts. No difference was demonstrated in overall freedom from death and retransplantation between the groups in the unmatched and matched cohorts (unmatched: hazard ratio (HR) 1.28, 95% confidence interval (CI) 0.79-2.07, = 0.32; matched: HR 1.06, 95% CI 0.59-1.89). = 0.89). In the unmatched cohort, overall freedom from chronic allograft dysfunction (CLAD) was significantly different between the groups (HR 1.64, 95% CI 1.07-2.52, = 0.02); however, the cumulative CLAD incidence was similar (HR 0.72, 95% CI 0.48-1.1, = 0.13). In the matched cohort, the overall freedom from CLAD (HR 1.69, 95% CI 0.97-2.95, = 0.06) and cumulative CLAD incidence (HR 0.91, 95% CI 0.37-2.215, = 0.83) were similar between the groups. The EVLP era sub-analysis of the unmatched cohort in 2012-2014 had a significantly higher cumulative CLAD incidence in the EVLP group; however, this was not demonstrated in the matched cohort. All secondary outcomes were similar between the groups in the unmatched and matched cohorts. In conclusion, transplantation of marginal donor lungs after EVLP evaluation is non-detrimental compared to conventionally preserved donor lungs in terms of mortality, retransplantation, cumulative CLAD incidence, and secondary outcomes. Although the unmatched EVLP era of 2012-2014 had a significantly higher cumulative CLAD incidence, no such finding was demonstrated in the matched cohort of the same era.
肺灌注（体外肺灌注，EVLP）已显示出令人鼓舞的短期和中期结果，但其长期结果的数据有限。本研究评估了（1）EVLP的长期结果，以及（2）基于EVLP时代的亚组分析，此外还分析了接受EVLP处理的供体肺的受者与传统保存的供体肺的受者在未匹配和倾向评分匹配队列中的次要结局。纳入了2012年1月1日至2021年12月31日期间进行的双肺移植。共有57名接受者接受了EVLP处理的肺，相比之下，有202名未匹配的和57名匹配的接受者接受了未进行EVLP处理的肺。在未匹配和匹配队列中，EVLP组的平均PaO/FiO比值显著低于非EVLP组，平均BMI显著高于非EVLP组。在未匹配队列中，EVLP组吸烟史的比例显著更高，而在匹配队列中吸烟史情况相似。在未匹配和匹配队列中，两组之间在总体免于死亡和再次移植方面无差异（未匹配：风险比（HR）1.28，95%置信区间（CI）0.79 - 2.07，P = 0.32；匹配：HR 1.06，95% CI 0.59 - 1.89，P = 0.89）。在未匹配队列中，两组之间在总体免于慢性移植物功能障碍（CLAD）方面有显著差异（HR 1.64，95% CI 1.07 - 2.52，P = 0.02）；然而，累积CLAD发生率相似（HR 0.72，95% CI 0.48 - 1.1，P = 0.13）。在匹配队列中，两组之间在总体免于CLAD方面（HR 1.69，95% CI 0.97 - 2.95，P = 0.06）和累积CLAD发生率方面（HR 0.91，95% CI 0.37 - 2.215，P = 0.83）相似。对2012 - 2014年未匹配队列的EVLP时代亚组分析显示，EVLP组的累积CLAD发生率显著更高；然而，在匹配队列中未显示出这种情况。在未匹配和匹配队列中，两组之间所有次要结局相似。总之，在死亡率、再次移植、累积CLAD发生率和次要结局方面，与传统保存的供体肺相比，EVLP评估后边缘供体肺的移植并无不利影响。尽管2012 - 2014年未匹配的EVLP时代累积CLAD发生率显著更高，但在同一时代的匹配队列中未显示出这一结果。
