Outcomes associated with remote, centralized ex vivo lung perfusion (rc-EVLP) for donor lungs in a real-world setting.

Objective: Ex vivo lung perfusion (EVLP) has resulted in a significant increase in the use of extended-criteria donor lungs without negatively impacting survival outcomes. However, in-house EVLP is resource-intensive, thereby limiting accessibility. Remote, centralized EVLP (rc-EVLP) has been used with acceptable outcomes in a highly protocolized feasibility study, although has not been assessed in a clinical setting. We characterized outcomes of rc-EVLP in a real-world setting and provide clinical associations related to donor use.

Methods: We performed a dual-center, retrospective analysis of consecutive extended-criteria donor lungs evaluated on rc-EVLP between December 1, 2020, and March 20, 2023. Outcomes included transplantation rate, predictors of use, incidence of primary graft dysfunction grade 3 (PGD3), and 1-year survival. Group comparisons were examined using the Fisher exact test or Mann-Whitney test.

Results: Eighty-two donors were assessed by rc-EVLP; 65% would've been excluded in the previous feasibility trial. Forty-six lungs (56%) were ultimately transplanted. Vascular permeability, static compliance, and oxygen transfer all were associated with use. PGD3 incidence in rc-EVLP recipients was 17%, whereas 1-year survival was 93%. Donor from circulatory death (DCD) lungs assessed by rc-EVLP had a use of 6 of 19 (33%). Greater preprocurement partial pressure of oxygen, arterial/fraction of inspired oxygen ratio and greater oxygen transfer and static compliance assessed after 2 hours on EVLP were associated with increased DCD use. Although PGD3 incidence with DCD lungs was 33%, there was 100% 1-year recipient survival. Finally, 2-hour EVLP assessments may be sufficient for determining donor quality for all lungs.

Conclusions: Remote, centralized EVLP increases the use of extended-criteria donor lungs in a real-world setting and is associated with excellent outcomes. We provide objective criteria that are associated with the decision to use donor from brain death and DCD lungs assessed by rc-EVLP.