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

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.