Chan Ernest G, Deitz Rachel L, Donohue Jack K, Ryan John P, Suzuki Yota, Furukawa Masashi, Noda Kentaro, Sanchez Pablo G
Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Thorac Cardiovasc Surg. 2025 Jul;170(1):96-106.e4. doi: 10.1016/j.jtcvs.2024.10.041. Epub 2024 Nov 1.
We report outcomes associated with ex vivo lung perfusion (EVLP) lungs in high-risk lung transplant recipients utilizing a national database.
We performed a retrospective analysis of the United Network for Organ Sharing Database (January 1, 2018-March 31, 2024). High-risk status was defined as mean pulmonary arterial pressure >35 mm Hg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity-score matched analysis was performed on predictors of donor and recipient characteristics.
Risk of dying on the waitlist was significantly higher for high-risk candidates (hazard ratio, 1.69; 95% CI, 1.51-1.89; P < .001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%; P < .001), higher mortality on index admission (13% vs 8%; P = .04), and longer length of stay (29 vs 25 days; P = .006). EVLP modality was associated with survival time (P < .001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years; P < .02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients.
EVLP lungs were associated with higher rates of postoperative acute kidney injury and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.
我们利用一个全国性数据库报告高危肺移植受者中与体外肺灌注（EVLP）肺相关的结果。
我们对器官共享联合网络数据库（2018年1月1日至2024年3月31日）进行了回顾性分析。高危状态定义为平均肺动脉压>35 mmHg、再次肺移植或过渡到移植。除了单变量分析外，还对供体和受体特征的预测因素进行了倾向评分匹配分析。
高危候选者在等待名单上死亡的风险显著更高（风险比，1.69；95%CI，1.51 - 1.89；P <.001）。匹配后，203例EVLP病例与609例标准获取受者进行了匹配。EVLP组术后需要肾脏替代治疗的急性肾损伤发生率更高（27%对16%；P <.001），首次入院时死亡率更高（13%对8%；P =.04），住院时间更长（29天对25天；P =.006）。EVLP模式与生存时间相关（P <.001），便携式EVLP的生存时间明显短于标准病例（2.7年对4.7年；P <.02）。亚组分析发现，这种生存效应仅限于过渡和再次移植受者。
在高危肺移植受者中，EVLP肺与术后急性肾损伤发生率较高相关，便携式EVLP与较短的生存时间相关。然而，鉴于该候选人群在等待名单上的高死亡率，EVLP肺仍应被视为一种选择。
