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Establishment of a Novel Ex Vivo Lung Perfusion System for Rat Lungs After Circulatory Death
Published on: October 18, 2024
Unilateral vs Bilateral Lung Transplantation After Ex Vivo Lung Perfusion
Divyaam Satija1, Martin Walsh2, Theodore Dimitrov1
1Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Background:
Ex vivo lung perfusion (EVLP) has increased, but a knowledge gap in outcomes of unilateral and bilateral lung transplantation following EVLP exists.
Methods:
Lung transplantations after EVLP were identified from the United Network for Organ Sharing Database from February 28, 2018 to March 31, 2024. Recipients were stratified into unilateral and bilateral lung transplant groups. Multivariable logistic regression was used to identify factors associated with unilateral lung transplantation. Propensity score matching was used to balance recipient and donor baseline characteristics. Comparative statistics were used to assess postoperative outcomes between the groups.
Results:
There were 534 recipients identified in the bilateral group and 84 in the unilateral group. Factors associated with unilateral transplantation included increased recipient or donor age and recipient diagnoses of restrictive lung disease and pulmonary vascular disease, whereas increased pulmonary artery pressure and female donor sex were associated with bilateral transplantation. Before matching, the bilateral group had significantly longer perfusion times, length of stay, and prolonged intubation (5+ days) rates. Unadjusted midterm survival did not differ significantly between the groups (P = .88). After matching, bilateral lung transplant recipients had significantly longer perfusion times, length of stay, and higher prolonged intubation rates, but no differences in other postoperative outcomes. Adjusted midterm survival did not differ significantly, either (P = .79). Comparison of unilateral transplants with or without EVLP revealed similar results between the groups.
Conclusions:
After EVLP, bilateral lung transplant recipients had significantly increased length of stay and rates of prolonged intubation; however, midterm survival did not significantly differ between the unilateral and bilateral groups. These findings suggest that EVLP can be safely used for unilateral lung transplantation in appropriately selected recipients.
