Outcomes of lung transplantation using TorEx ex-vivo lung perfusion

Ex-vivo lung perfusion (EVLP) has expanded donor lung utilization, with over 1000 cases performed at our center since 2008. A next-generation Toronto EVLP system (TorEx EVLP) was introduced in December 2022, enabling simplified circuit setup by loading an organ chamber into an all‑in‑one device, potentially facilitating EVLP use at less experienced centers. This study reports the initial experience with TorEx EVLP and compares outcomes with (1) first‑generation EVLP and (2) conventional lung transplantation without EVLP.

In this single-center retrospective cohort study, 1067 EVLP procedures were performed from September 2008 to September 2024 (first-generation EVLP [G1], n=874; TorEx EVLP [G2], n=193). Post-transplant short- and long-term outcomes were compared among G1, G2, and contemporaneous direct transplants without EVLP (direct, n=1575).

Of 1067 EVLP cases, 684 were accepted for transplant (utilization: G1 64.4%, G2 62.7%), and 700 transplants were performed (including 16 split singles). G1 and G2 had significantly higher DCD donor use (direct vs G1 vs G2: 17% vs 48% vs 60%, p<0.001) and lower donor P/F ratios (422 vs 368 vs 368 mmHg, p<0.001). Recipients in G1 and G2 were older than direct recipients (59 vs 61 vs 65 years, p<0.05). Post‑transplant outcomes were similar across groups, including PGD3 at 72 h (15% vs 16% vs 10%, p=0.21), extubation within 72 h (65% vs 64% vs 68%, p=0.67), overall survival, and CLAD‑free survival.

Despite higher-risk donor use, outcomes with both first- and next-generation Toronto EVLP systems were comparable to direct transplantation.