1000例用于肺移植的体外肺灌注：单中心经验

1,000 Cases of Ex Vivo Lung Perfusion for Lung Transplantation: A Single Centre Experience.

作者信息

Keshavjee Shaf, Sage Andrew T, Borrillo Thomas, Yeung Jonathan C, Piyasena Deween, Wakeam Elliot, Donahoe Laura, Waddell Thomas K, de Perrot Marc, Pierre Andrew, Balachandran Sharaniyaa, Ghany Rasheed, Ali Aadil, Yasufuku Kazuhiro, Cypel Marcelo

机构信息

Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

出版信息

J Thorac Cardiovasc Surg. 2025 Sep 3. doi: 10.1016/j.jtcvs.2025.08.036.

DOI:10.1016/j.jtcvs.2025.08.036

PMID:40912632

Abstract

OBJECTIVES

To report the impact of ex vivo lung perfusion (EVLP) on lung transplantation practices and clinical outcomes. This study presents the largest single-centre EVLP experience to date, highlighting how EVLP has transformed clinical lung transplantation with expansion of donor access, program growth, and the safe use of extended criteria donor lungs.

METHODS

We conducted a retrospective analysis of 1,000 consecutive EVLP procedures performed between 2008 and 2024 at University Health Network's Toronto General Hospital. Donor lungs were evaluated using the standardized normothermic acellular Toronto EVLP Technique. We analyzed donor and recipient demographics, procedural characteristics, transplant rates, and post-transplant outcomes.

RESULTS

Of 1,000 EVLP procedures, approximately 65% of lungs were accepted for transplant. These grafts accounted for 659 lung transplants, representing 29% of all transplants performed during the study period. EVLP volume grew steadily and contributed to an overall increase in transplant activity. The use of moderate- and high-risk donor lungs, including those following circulatory death, increased over time. In concordance with these shifts, median ischemia time increased from 224 to 414 minutes, and the proportion of cases achieving a final ΔpO ≥ 400 mmHg on EVLP declined from 68% to 52%. Post-transplant outcomes including ICU duration, time to extubation, primary graft dysfunction, and overall survival were not significantly different between EVLP and non-EVLP lung recipients.

CONCLUSIONS

EVLP has emerged as a safe, effective and scalable platform for donor lung evaluation. Its integration into clinical practice has supported broader donor organ utilization and excellent patient outcomes, while laying the foundation for continued innovation in lung transplantation.

摘要

目的

报告体外肺灌注（EVLP）对肺移植实践和临床结果的影响。本研究展示了迄今为止最大规模的单中心EVLP经验，突出了EVLP如何通过扩大供体来源、项目发展以及安全使用边缘供肺来改变临床肺移植。

方法

我们对2008年至2024年期间在大学健康网络多伦多总医院连续进行的1000例EVLP手术进行了回顾性分析。使用标准化的常温无细胞多伦多EVLP技术对供肺进行评估。我们分析了供体和受体的人口统计学特征、手术特点、移植率以及移植后的结果。

结果

在1000例EVLP手术中，约65%的肺被接受用于移植。这些移植物促成了659例肺移植，占研究期间所有移植手术的29%。EVLP的数量稳步增长，并导致移植活动总体增加。随着时间的推移，中、高风险供肺的使用增加，包括循环死亡后的供肺。与这些变化一致，中位缺血时间从224分钟增加到414分钟，在EVLP上最终ΔpO≥400 mmHg的病例比例从68%下降到52%。EVLP肺移植受者和非EVLP肺移植受者在移植后的结果，包括重症监护病房（ICU）住院时间、拔管时间、原发性移植物功能障碍和总体生存率，没有显著差异。